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Biomedical subjects

Olli S Miettinen

Publications and source records attributed to Olli S Miettinen.

At least 19 recordsLinked to original sources
PubMed2006

Survival of patients with stage I lung cancer detected on CT screening.

BACKGROUND: The outcome among patients with clinical stage I cancer that is detected on annual screening using spiral computed tomography (CT) is unknown. METHODS: In a large collaborative study, we screened 31,567 asymptomatic persons at risk for lung cancer using low-dose CT from 1993 through 2005, and from 1994 through 2005, 27,456 repeated screenings were performed 7 to 18 months after the previous screening. We estimated the 10-year lung-cancer-specific survival rate among participants with clinical stage I lung cancer that was detected on CT screening and diagnosed by biopsy, regardless of the type of treatment received, and among those who underwent surgical resection of clinical stage I cancer within 1 month. A pathology panel reviewed the surgical specimens obtained from participants who underwent resection. RESULTS: Screening resulted in a diagnosis of lung cancer in 484 participants. Of these participants, 412 (85%) had clinical stage I lung cancer, and the estimated 10-year survival rate was 88% in this subgroup (95% confidence interval [CI], 84 to 91). Among the 302 participants with clinical stage I cancer who underwent surgical resection within 1 month after diagnosis, the survival rate was 92% (95% CI, 88 to 95). The 8 participants with clinical stage I cancer who did not receive treatment died within 5 years after diagnosis. CONCLUSIONS: Annual spiral CT screening can detect lung cancer that is curable.

Adult↗
PubMed2006

Women's susceptibility to tobacco carcinogens and survival after diagnosis of lung cancer.

CONTEXT: It has been hypothesized that women are more susceptible to tobacco carcinogens than men, but after diagnosis of lung cancer, they have better survival rates than men. OBJECTIVE: To add to the evidence on the lung cancer risk of women who smoke and their survival after diagnosis of lung cancer, conditional on other prognostic indicators and compared with men of the same age who smoke. DESIGN, SETTING, AND PARTICIPANTS: Nonexperimental, etiologic study with prospective collection of data based on baseline computed tomographic screening for lung cancer and follow-up of diagnosed cases of lung cancer in North America in 1993-2005. A total of 7498 women and 9427 men were screened, all of whom were asymptomatic, aged at least 40 years, and had a history of cigarette smoking. MAIN OUTCOME MEASURES: Comparing women with men, the prevalence odds ratio (OR) for screen-detectable lung cancer (conditional on age and smoking history) and the hazard ratio of fatal outcome of lung cancer (conditional on smoking history, disease stage, tumor cell type, and resection). RESULTS: Lung cancer was diagnosed in 156 women and 113 men (rates of 2.1% and 1.2%, respectively). The prevalence OR comparing women with men was 1.9 (95% confidence interval [CI], 1.5-2.5). The hazard ratio of fatal outcome of lung cancer comparing women with men was 0.48 (95% CI, 0.25-0.89). CONCLUSION: Women appear to have increased susceptibility to tobacco carcinogens but have a lower rate of fatal outcome of lung cancer compared with men.

Aged↗
PubMed2006

Computed tomographic screening for lung cancer: the relationship of disease stage to tumor size.

BACKGROUND: The relationship of lung cancer stage to tumor diameter has been identified as a prognostic indicator. We report on the stage-size relationship of these asymptomatic, latent lung cancer cases diagnosed by computed tomographic screening. METHODS: Baseline and repeat screening of 28 689 people following the International Early Lung Cancer Action Program regimen of screening has resulted in 464 diagnoses of lung cancer. Each case was characterized according to tumor diameter, consistency (solid, part solid, or nonsolid), and the presence or absence of identifiable metastases (N0 M0) at the time of diagnosis, regardless of whether it was delayed. RESULTS: For the 436 non-small cell carcinomas, the percentages of cases with no metastases (N0 M0) were 91%, 83%, 68%, and 55% for the categories 15 mm or less, 16 to 25 mm, 26 to 35 mm, and 36 mm or greater, respectively. The gradients in the successive percentages of N0 M0 cases were significantly different (P = .02, 1-sided), except between the last 2 categories, and held for solid nodules, were suggestive for part-solid ones, but were not suggestive for nonsolid ones. For the 28 small cell carcinomas, the percentages of N0 M0 cases were 67% and 23% (P = .01, 1-sided), respectively, for those 25 mm or less compared with those greater than 25 mm. CONCLUSIONS: Lymph node status has a strong relationship to tumor diameter for non-small cell and small cell cancers. The percentages of N0 M0 cases in screen-diagnosed lung cancers are much higher than previously reported in the Surveillance, Epidemiology, and End Results registry. These results provide direct evidence of a stage-size relationship in a screened population.

Adenocarcinoma↗
PubMed2006

An 'unconditional-like' structure for the conditional estimator of odds ratio from 2 x 2 tables.

In the estimation of the odds ratio (OR), the conditional maximum-likelihood estimate (cMLE) is preferred to the more readily computed unconditional one (uMLE). However, the exact cMLE does not have a closed form to help divine it from the uMLE or to understand in what circumstances the difference between the two is appreciable. Here, the cMLE is shown to have the same 'ratio of cross-products' structure as its unconditional counterpart, but with two of the cell frequencies augmented, so as to shrink the unconditional estimator towards unity. The augmentation involves a factor, similar to the finite population correction, derived from the minimum of the marginal totals.

Algorithms↗
PubMed2006

Etiology in a taxonomy of illnesses.

According to what Robert Koch termed the etiological standpoint, illnesses are best understood and controlled by focusing on their causes, including in their definitions and, thus, in the construction of their taxonomies. In some ways flawed, this standpoint has been misunderstood and misapplied. A taxonomy based solely on etiology was an unrealistic dream in the context of 'the bacteriological revolution', and it also is unrealistic in the present context of 'the genetic revolution.' We argue that the illnesses in a taxonomy of them are in some cases best defined directly in terms of their respective somatic anomalies, in some others indirectly by the unique and universal etiology of that anomaly (left unspecified) in a 'deeper' somatic anomaly, and in yet others as a combination of these; and when the somatic anomaly for direct definition remains unknown, it is to be defined indirectly by the clinical syndrome that is its patient-relevant manifestation, possibly in conjunction with a somatic cause. We note, also, that these taxonomic issues have no material bearing on epidemiologists' etiologic research for the knowledge base of community-level preventive medicine.

Disease↗
PubMed2006

Computed tomography screening for lung cancer: prospects of surviving competing causes of death.

PURPOSE: The primary objective of this study was to shed light on the frequency of death from a "competing" cause among persons who enter into computed tomography (CT) screening for lung cancer and to determine the 5- and 10-year rates of death from causes other than lung cancer in a cohort of older smokers and former smokers with the initiation of CT screening for lung cancer. PATIENTS AND METHODS: We followed a cohort of 2141 men and women aged 60-75 years with a history of 30-100 pack-years of cigarette smoking who enrolled for CT screening for lung cancer in 1993-2004. The National Death Index retrieval program was used to identify all deaths and causes of death. Follow-up time from the date of the initial CT to death, loss to follow-up, or December 31, 2004, whichever came first, was calculated for each subject. Median duration of follow-up was 50 months (range, 1-133 months). Kaplan-Meier analysis was used to derive the 5- and 10-year survival rates with the exclusion of deaths from lung cancer. RESULTS: The 5- and 10-year survival rates, conditional on not dying from lung cancer, were 96% and 90.7%, respectively. The corresponding 95% confidence intervals were 95%-97% and 88.2%-95.2%, respectively. CONCLUSION: Older smokers and former smokers seeking and receiving CT screening for lung cancer have a low 10-year risk of dying from causes other than lung cancer, and early treatment of screen-diagnosed cancer can be life-saving.

Aged↗
PubMed2004

CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans.

PURPOSE: To assess the frequency with which a particular, possibly optimal work-up of noncalcified nodules less than 5.0 mm in diameter identified on initial computed tomographic (CT) images at baseline screening leads to a diagnosis of malignancy prior to first annual repeat screening, compared with a possibly optimal work-up of larger nodules. MATERIALS AND METHODS: Two series of baseline CT screenings in high-risk people were retrospectively reviewed. The first series (n = 1,000) was performed in 1993-1998; the second (n = 1,897), in 1999-2002. In each series, cases in which the largest noncalcified nodule detected was less than 5.0 mm in diameter and those in which it was 5.0-9 mm were reviewed to determine whether diagnostic work-up prior to first annual repeat screening showed or would have shown nodule growth and led or would have led to a diagnosis based on biopsy or surgical specimens. RESULTS: The frequency with which malignancy was or could have been diagnosed when the largest noncalcified nodule was less than 5.0 mm in diameter was 0 of 378, whereas when the largest noncalcified nodule was 5.0-9 mm in diameter, the frequency was 13 or 14 of 238. If persons with only nodules smaller than 5.0 mm had merely been referred for first annual repeat screening without immediate further work-up, the referrals for such work-up would have been reduced by 54% (from 817 [28%] to 385 [13%] of 2,897). CONCLUSION: In modern CT screening for lung cancer at baseline, detected noncalcified nodules smaller than 5.0 mm in diameter do not justify immediate work-up but only annual repeat screening to determine whether interim growth has occurred.

Adult↗
PubMed2004

Women's susceptibility to tobacco carcinogens.

STUDY OBJECTIVES: To assess lung cancer risk of smoking women relative to that of equally smoking men. METHODS: The study base was constituted by baseline CT screenings for lung cancer on 1202 women and 1288 men, at least 40 years of age and with at least 10 pack-years of cigarette smoking. The prevalence-odds (incidence-density) ratio contrasting women with men was calculated. Confoundings by age and the particulars of smoking history were controlled in logistic regression analysis. RESULTS: For the prevalence-odds ratio contrasting women with men, upon control of age and smoking history, the point estimate was 2.7 and the 95% interval estimate 1.6-4.7. The diagnosed cancers were of equally 'aggressive' types between the two genders. CONCLUSIONS: At variance with evidence from cohort studies, this evidence from a screening experience calls for further consideration of the hypothesis that women are more susceptible to tobacco carcinogens than are men.

Adult↗
PubMed2004

Epidemiology: quo vadis?

In our etiologic research, we epidemiologists need to leave behind the concepts of 'cohort' study and 'case-control' study and adopt that of the etiologic study as the singular substitute for these. We then need to realize that the etiologic study is well suited to be viewed as paradigmal for intervention studies. We finally need to become serious about object design before methods design in both etiologic and intervention research. Once these developments have occurred, we'll be ready for truly meaningful research to advance the knowledge base of both types of causality-oriented 'gnosis' in the practice of clinical medicine, etiognosis and intervention-prognosis; and descriptive-prognostic study we'll see as inherent in any intervention-prognostic study. As for diagnostic research, then, we need to come to see it as nothing but a special case of our familiar descriptive prevalence research. Because of this readily attainable theoretical readiness peculiar to us research epidemiologists, and for other reasons besides, only we can assume the central role in the production of the knowledge base for scientific medicine. We consequently have the obligation to assume this larger and higher, meta-epidemiologic mission--and some even higher ones besides.

Causality↗