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Biomedical subjects

P Boyle

Publications and source records attributed to P Boyle.

At least 19 recordsLinked to original sources
PubMed1996

Decrease in mortality from benign prostatic hyperplasia: a major unheralded health triumph.

PURPOSE: A systematic examination of all available mortality data from benign prostatic hyperplasia (BPH) between 1950 and 1990 was done to estimate the changing international mortality pattern of this condition. MATERIALS AND METHODS: Mortality data in which BPH was the underlying cause of death were abstracted from the World Health Organization mortality data base. These data were available from a variety of international countries (in many since 1950). RESULTS: Mortality rates have decreased with considerable magnitude in developed western countries between the early 1950s and late 1980s. This fact could reasonably be attributed to the improved management of the most severe complications of BPH and to improvements in surgery and anesthesia, which have made surgical interventions of the prostate possible in a greater proportion of men, and safer in the immediate and subsequent postoperative period. CONCLUSIONS: The decreases noted in western countries, such as the United Kingdom (where 8,700 fewer men die each year presently than would be expected if the BPH mortality rates from the early 1950s still applied), United States (13,681 fewer deaths) and France (2,884 fewer deaths), indicate a considerable but unheralded achievement for modern medicine. Unfortunately, these decreases have not been observed to the same extent in central and eastern Europe and South America, where the residual high mortality rates could be lowered by education, and the widespread availability of modern surgical and anesthetic equipment.

Cause of Death↗
PubMed1995

Breast-cancer risk and oral contraceptive use in Slovenian women aged 25 to 54.

Results of a previous case-control study in Slovenia showed a significantly elevated risk of breast cancer for ever-OC users aged 25 to 54 years. A further study was conducted in 1988-1990 in the whole of Slovenia, employing more rigorous epidemiological methodology. Cases were 624 women with breast cancer, aged 25 to 54 years, diagnosed at the Institute of Oncology in Ljubljana and other Slovenian hospitals. Controls were 624 women identified through the Population Registry, randomly selected and matched with cases by date of birth and commune of residence. Data were collected by personal interview, using coloured photographs of packages of all OC on the Slovenian market since 1964. A calendar of reproductive life events was constructed with participants to improve estimation of exposure. The adjusted odds ratio (OR) for ever-users was 1.09. There was no increase in risk with total duration of use, interval since first use, age at starting OC, according to use before or after first delivery and time between menarche and age at first use. Increased risk (OR = 2.92) was found for OC users at the time of diagnosis and for those stopping them less than 6 months before (current users). The risk was not increased for those who stopped OC more than 6 months before diagnosis. The results of this study are consistent with most studies showing no overall effect of OC in women aged till 55 years ever using them. Increased risk of breast cancer in current OC users suggests a possible promoting effect of the pill in susceptible women, and indicates the need for careful breast surveillance of these women while they are using OC and in the period immediately following cessation.

Adult↗
PubMed1995

Time trend in pancreatic cancer incidence in Connecticut, 1935-1990.

A total of 13,246 incident pancreatic cancer cases, reported to the Connecticut Tumor Registry between 1935 and 1990, were included in our study. Results indicate that the overall age-adjusted incidence rate of pancreatic cancer increased between 1935 and 1964 in males, and leveled off thereafter. Since 1975, the incidence rate has in fact been decreasing, from 12.04/100,000 in 1975-79 to 10.44/100,000 in 1985-90. In females, the overall age-adjusted incidence rate also increased between 1935 and 1974. Since then, however, it has remained relatively stable. Age-specific incidence rates also show no signs of an increase in rate from any age group, or from either sex for recent birth cohorts. There is also no clear increase in the incidence of pancreatic cancer in any of the ethnic/gender categories since the early 1970s. Age-period-cohort modeling shows that the increasing birth cohort trend peaked among those born around 1920-1925 and, for recent birth cohort, a slightly decreasing trend was observed in both males and females. Our study reveals no signs of an increase in the immediate future in pancreatic cancer incidence rate in any of the sex, ethnic and age groups in Connecticut.

Adult↗
PubMed1995

International patterns in the occurrence of Hodgkin's disease in children and young adult males.

It was reported over 20 years ago that there were distinct age-specific patterns of Hodgkin's disease incidence in countries with different levels of economic development, and that there was an inverse relationship between the incidence of Hodgkin's disease in children and young adults within countries. Such observations were important, leading to hypotheses on the possibly infectious aetiology of the disease. Since the initial report, diverging trends in the incidence of Hodgkin's disease in children and young adults have been observed, and data from a much larger number of countries and cancer registries have become available. This led us to reassess international age-related incidence patterns of Hodgkin's disease occurrence. Recent data show distinct differences in age-specific Hodgkin's disease incidence patterns in different geographic regions. In general, the United States (US) and European countries had the pattern of low childhood rates and high young adulthood rates. However, countries which are not part of the European Union (EU), mainly Baltic states and countries of central and eastern Europe, showed a variant of this pattern: similarly high young adult rates, but rates in children higher than those in the US and EU. Incidence-rate patterns for Latin American countries differed from those previously observed, with a shift towards patterns observed in more economically developed countries. Analysis of incidence data from earlier sources dating back to 1963 confirmed the original finding of an inverse association in incidence rates (c. 1963-1967) using a selected group of cancer registries, but not when all data were considered. This association has become weaker over the past 20 years. Using current incidence rates (1983-1987), no association between Hodgkin's disease rates in children aged 5 to 14 years (as well as 0 to 9 years) and young adults (20 to 34 years) was found.

Age Factors↗
PubMed1995

Lung cancer and tobacco smoking.

The dominant role of tobacco smoking in the causation of lung cancer has been repeatedly demonstrated over the past 50 years. Current lung cancer rates reflect cigarette smoking habits of men and women in the past decades, but not necessarily current smoking patterns, since there is an interval of several decades between the change in smoking habits in a population and its consequences on lung cancer rates. Over 90% of lung cancer may be avoidable simply through avoidance of cigarette smoking. There is at present a huge premature loss of life world-wide caused by smoking. Rates of lung cancer present in central and eastern Europe at the present time are higher than those ever before recorded elsewhere; lung cancer has increased 10-fold in men and eightfold in women in Japan since 1950. There is a world-wide epidemic of smoking among young women which will be translated into increasing rates of tobacco-related disease, including cancer, in the coming decades. There is another epidemic of lung cancer and tobacco-related deaths building up in China as the cohorts of men in whom tobacco smoking became popular reach ages where cancer is an important hazard. Many solutions have been attempted to reduce cigarette smoking and increasingly many countries are enacting legislation to curb this habit. Cigarette smoking remains the number one target for Public Health action aimed at reducing cancer risk in the general population. General practitioners, hospital physicians and everyone working in oncology have a particularly important exemplary role to play in this process.

Female↗
PubMed1995

Patterns of childhood cancer mortality: America, Asia and Oceania.

Age-standardised mortality rates for childhood cancers for the calendar period 1950-1989 were reviewed for 22 countries (Canada, U.S.A., 10 Latin American countries or territories, Egypt, seven countries or territories from Asia, Australia and New Zealand) using data from the World Health Organization database. The highest mortality rates (between 6 and 7.5/100,000 boys, between 5 and 6/10,000 girls) for all childhood neoplasms were registered in Latin American countries (Uruguay, Cuba, Argentina, Costa Rica), Kuwait, New Zealand and Singapore. Rates were low in most developed countries, such as Canada, U.S.A., Australia, Japan and Israel (3.5 to 4.5/100,000). The pattern was similar for leukaemias, which account for approximately 50% of all childhood cancer mortality. From the 1960s onwards, a 50% decline in childhood cancer mortality was observed in the U.S.A. and Canada, and substantial declines were also observed in other developed countries, such as Australia, Israel and Japan. The pattern was much less favourable for other areas of the world, including Latin America and a few countries from Asia for which there were data. These declines in childhood cancer mortality are essentially attributable to improved management of the disease. The delay observed in the decline in mortality for most developing countries emphasises the scope and the importance of extending adequate treatments for childhood cancers to these areas of the world.

Adolescent↗
PubMed1995

European School of Oncology Advisory report to the European Commission for the "Europe Against Cancer Programme" European Code Against Cancer.

A European School of Oncology Advisory Group has reviewed the European Code Against Cancer after its initial use over a 6-year period. With minor modifications, the original ten recommendations were found to be adequate, although it was agreed that an Annex was necessary to explain the scientific evidence supporting each point, and is presented herewith. Tobacco smoking clearly remains the most important cause of cancer, and now it can be quantified better than ever before. It is also clear that it is never too late to stop smoking: stopping even in middle age, prior to the onset of serious illness has a beneficial effect on life expectancy. Alcohol drinking is an important cause of cancer, and yet modest consumption levels protect against cardiovascular disease mortality. The optimal strategy seems to be a consumption not exceeding 2-3 drinks per day, although this limit may be lower for women. Increased consumption of fruits and vegetables, reduction in consumption of fatty foods, reduction of obesity and increased physical activity can all be recommended to reduce cancer risk. Exposure to excessive sunlight remains a problem which should be limited. Control of occupational cancer is a three-way partnership: legislation identifies and limits exposure to known carcinogens, employers enact the legislation and workers should respect the measures introduced. There are a number of signs and symptoms which may lead to cancer being diagnosed earlier, and patients with these should be referred to a doctor. For women, participation in organised programmes of cervical cancer and breast cancer (after 50 years of age) should lead to a reduction in mortality from these forms of cancer. The key element is organised programmes, where quality control and quality assurance are in force. These revised recommendations are the result of an agreement following advice, review and dialogue with cancer experts throughout Europe. They were approved by the European Community Cancer Experts at their meeting in Bonn on 28-29 November 1994. Their implementation by the European population should greatly reduce cancer incidence and mortality.

Alcohol Drinking↗
PubMed1995

Alcohol, tobacco, diet and the risk of oral cancer: a pooled analysis of three case-control studies.

This combined analysis of data from three large case-control studies of oral cancer confirms the important effect of tobacco in the aetiology of the disease. The studies have been conducted in the United States, Italy and China and results for risks associated with tobacco smoking were generally consistent across centres, while those for alcohol were not; increased risks amongst alcohol drinkers were evident in two centres but not in the study conducted in Turin, Italy. In addition, the combined analysis had large enough numbers to analyse the risk of tobacco consumption in non-drinkers. In females these showed increased risks while in males the effect of tobacco alone was weaker. Given the popularity of tobacco smoking, and its consequent high attributable risk in terms of oral cancer it is reassuring, in terms of public health, that cessation will result in a substantial reduction in risk; a 30% reduction in risk for those stopping smoking between 1 and 9 years, and a 50% reduction for those stopping more than 9 years. Although encouraging smokers to stop should be the principal aim, decreases in risk for everyone could be achieved by encouraging high fruit and vegetable consumption.

Adult↗
PubMed1995

European School of Oncology Advisory report to the European Commission for the Europe Against Cancer Programme: oral carcinogenesis in Europe.

A European School of Oncology Advisory Group has reviewed current knowledge on the epidemiology, treatment and prevention of cancer of the oral cavity. While the major factors in the aetiology of such cancers are thought to be well understood, i.e. tobacco and alcohol consumption, current increases in the occurrence of the disease, especially in young adults throughout Europe, are cause for concern. The reasons for such increases are not clearly evident and the Advisory Group has suggested further work which is required to be carried out to understand the aetiology. In treatment of the disease there have been no major improvements in survival for patients in recent decades and the importance of examining new radiotherapy modalities and defining the role of chemotherapy is emphasized. Primary prevention of oral cancer could be achieved by stopping smoking tobacco, limiting alcohol consumption to a minimum (2-3 drinks per day) and increasing intake of fruits and vegetables. To supplement these actions, while neither population screening programmes nor screening trials could be recommended by the Advisory Group, initial chemoprevention trials have produced some promising results and this represents an interesting area which is the focus of much current research.

Europe↗
PubMed1995

Worldwide patterns of prevalence and mortality from benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) can be found in 88% of autopsies in men > or = 80 years, with compatible symptomatology reported in nearly 50% of men aged > or = 50 years in the general population. Despite such a common occurrence, little is known with any certainty about the epidemiology of BPH (for which "prostatism" is a commonly, and wrongly, used synonym). Knowledge of risk factors is sparse: analytic epidemiologic studies of BPH are difficult to conduct. It is essential to establish an epidemiologic definition of BPH for these reasons. Both BPH and prostatism are the problems that seem set to increase in absolute terms. They are clearly identified as priority areas for research into their causes and treatment. However, it is clear that there is a great need for more epidemiologic information, particularly regarding prostatism, whose occurrence is unknown in many parts of the world.

Global Health↗
PubMed1995

Geographical and temporal patterns of incidence and mortality from prostate cancer.

In many countries of the world, prostate cancer is the second most common form of cancer in men, and in the United States it is now in first rank. It is an important public health problem, with > 0.25 million new cases diagnosed worldwide in the year 1985. Whereas earlier large increases in the incidence of prostate cancer were apparent throughout the world, the mortality rate has remained constant in generations of men born since the early years of this century. Most importantly, given that in several countries the increased number of children born after World War II will be in their mid-50s in the early part of the 21st century (at an age when cancer risk is becoming an important consideration), and coupled with the trends in increasing life expectancy, the consequence will be an increase in absolute terms in the number of cases of prostate cancer diagnosed. In the absence of treatment improvements and with prospects for prevention by modification of lifestyle remote within current knowledge, there will also be an increase in the number of deaths from prostate cancer worldwide. The situation would be further augmented by the presence of a temporal trend in risk that is widely reported from many countries and unlikely to be entirely artefact.

Age Factors↗
PubMed1995

Impact of symptoms of prostatism on level of bother and quality of life of men in the French community.

The impact of symptoms of prostatism on level of bother and quality of life of French men was assessed nationwide, in a representative community sample of 2,011 subjects 50 to 84 years old. Bothersome level and quality of life associated with 12 urinary symptoms were assessed by face-to-face interviews, using a previously validated questionnaire for benign prostatic hyperplasia (BPH). The international prostate symptom score and the American Urological Association (AUA) bothersome index were also computed. Urgency was by far the most bothersome symptom in French men. Nocturia and wetting underclothes ranked second in subjects who did not undergo prostate surgery and among symptomatic patients, respectively. Overall, symptom frequency accounted for 72% of the variability of symptom bother but the form and strength of this correlation varied among symptoms from 0.18 to 0.43. Among the symptomatic subjects who had not yet undergone prostate surgery 11%, 10% and 79%, respectively, were dissatisfied, neutral and satisfied with the current urinary condition. Satisfaction with the urinary condition was positively linked to symptom frequency (p < 0.001) and symptom bother level (p < 0.001). Nocturia, dysuria, daytime repeat voiding, wetting clothes and urgency, when severely bothersome, were independent predictors of decreased satisfaction with the urinary condition (p = 0.01). Approximately half of the patients with severe BPH symptoms expressed serious worries and concerns with the urinary condition, and sizable levels of interference by the symptoms with daily activities, which are potentially affected by urinary troubles. The AUA bother index was the best determinant of subject level of worry about the urinary condition and of interference with daily life. This study supported the concomitant use of the international prostate symptom score and the AUA bother index in further research studies of BPH related impairments in quality of life.

Aged↗