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Biomedical subjects

R R Connelly

Publications and source records attributed to R R Connelly.

At least 55 records · Page 3Linked to original sources

Marriage and divorce after childhood and adolescent cancer.

As part of a study of long-term survivors of childhood and adolescent cancer, we interviewed 2170 survivors and 3138 sibling control subjects about their marital histories. In a proportional hazards analysis, both male and female survivors were less likely to be ever married than control subjects (rate ratio [RR] for males, 0.87; 99% confidence interval, 0.76 to 0.99; RR for females, 0.86; 99% confidence interval, 0.76 to 0.97). Survivors of brain and central nervous system tumors accounted for most of the marriage deficit, which was greater in men than in women (RRs, 0.48 and 0.73, respectively). Survivors married at the same average age as control subjects, except for survivors of central nervous system tumors, who married slightly later. The average length of first marriages was shorter in survivors than in control subjects. Men who had survived central nervous system tumors diagnosed before 10 years of age and male survivors of retinoblastoma had higher divorce rates than male control subjects (RRs, 2.9 and 1.9, respectively). In this cohort (which received less intense therapy than given in current practice), altered marriage practices are substantial only among survivors of central nervous system tumors.

Adolescent↗

Childhood cancer survivors' knowledge of their diagnosis and treatment.

PURPOSE: To determine what factors correlated with the failure of the survivors of childhood cancer to acknowledge their diagnosis. STUDY DESIGN: A follow-up interview with 1928 adults who survived childhood cancer to evaluate the late effects of cancer and its treatment. Cancer was diagnosed in these survivors between 1945 and 1974 before they reached age 20: subjects had to have survived for at least 5 years and to have reached age 21. RESULTS: Fourteen percent of the survivors of malignancies at sites other than the central nervous system said that they had not had cancer. This proportion differed according to the survivors' race, the type of tumor and its treatment, the level of their father's education, the year of diagnosis, and the center where the tumor was diagnosed. Among survivors who knew that they had cancer previously, however, most (81%) correctly identified the type of treatment they had received. CONCLUSIONS: Physicians should be aware that a substantial proportion of long-term survivors of childhood cancer may not reveal their past history of cancer and its treatment, and possible clues to the cause of the presenting condition may thus be missed.

Adult↗

Survival patterns for malignant mesothelioma: the SEER experience.

Statistical analyses of 1,475 histologically confirmed cases of malignant mesothelioma ascertained through the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute for the years 1973-1984 showed age at diagnosis, sex, stage of disease, type of treatment, and geographic area of residence to be important predictors of patient survival, although type of treatment may be confounded with prognostic factors (patients selected for surgical treatment tended to have better performance status than other patients). Women below the age of 50 had an unusually long survival, even after adjustment for the effects of other variables in the model. A relatively large proportion of female cases had site of disease designated as peritoneum, but site was not a significant prognostic factor. These results suggest that age, gender and stage of disease should be carefully considered in designing and analyzing clinical trials for persons with mesothelioma. Survival was shorter in the 4 SEER registries which had shipbuilding as a major industry than in the others with less potential asbestos exposure, offering weak support for the hypothesis that asbestos-exposed cases of mesothelioma have worse survival experience than other cases.

Adult↗

Reproductive problems and birth defects in survivors of Wilms' tumor and their relatives.

In a retrospective cohort study of 47 Wilms' tumor survivors and their 77 sibling controls, female survivors had a fourfold excess risk (risk ratio, 4.1; 95% confidence interval, 1.7-10.1) for any adverse livebirth outcome, including birth defects, compared with their sibling controls. Wives of male survivors had no apparent excess risk for problem pregnancies. The families had a number of severe reproductive problems and major birth defects, such as primary amenorrhea in two survivors, bicornuate uterus in two survivors and one control, and mental retardation in one male survivor and a male control. The son of a female survivor died after bilateral Wilms' tumors. Birth defects in the offspring of female survivors are compatible either with intrauterine constraint, possibly due to radiation-induced fibrosis or with the complex of malformations associated with Wilms' tumor. Female survivors of Wilms' tumor appear to be at increased risk for a variety of reproductive problems, from sterility to fetal loss, early delivery, and birth defects in offspring. Furthermore, relatives of survivors of Wilms' tumor may be at risk of having associated birth defects, with clinically significant consequences.

Adolescent↗

Educational achievement of long-term survivors of childhood and adolescent cancer.

In a retrospective cohort study, the level of education attained by 2,283 long-term survivors of childhood and adolescent cancer was investigated and compared with that of 3,270 sibling controls. Survivors of central nervous system tumors were significantly less likely than controls to complete eight grades of school or, if they completed high school, to enter college. No significant differences in educational achievement were found for survivors of non-central nervous system cancers. The educational deficit of survivors of brain tumors was especially striking for tumors of the ventricles or cerebral hemispheres, and the deficit was more severe for those treated with radiation therapy than by surgery alone. Early age at diagnosis of a central nervous system tumor was associated with a larger educational deficit than late age at diagnosis. These findings are reassuring for the majority of long-term survivors of childhood and adolescent cancers given therapies used prior to 1975.

Adult↗

Epstein-Barr virus serology in the control of nasopharyngeal carcinoma.

Epstein-Barr virus (EBV) is suspected as being etiologically related to nasopharyngeal carcinoma (NPC). Antibodies to EBV antigens have been used in the early detection of NPC and serologic assays are being utilized in the mass screening of high risk populations. While areas of potential application to disease control, such as therapy, are still in the developmental phase, EBV serology has been reported to be of value in the detection of early relapse. Since the data from a series of studies provide conflicting results, however, in this report we review the current information regarding detection of early relapse and describe specific areas that require particular attention if the role of EBV serology in this aspect of NPC control is to be well defined.

Antigens, Viral↗

Effects of treatment on fertility in long-term survivors of childhood or adolescent cancer.

In a retrospective cohort study of survivors of cancer and of controls, we estimated the risk of infertility after treatment for cancer during childhood or adolescence. We interviewed 2283 long-term survivors of childhood or adolescent cancer diagnosed in the period from 1945 through 1975, who were identified at five cancer centers in the United States. Requirements for admission to the study were diagnosis before the age of 20, survival for at least five years, and attainment of the age of 21. In addition, 3270 controls selected from among the survivors' siblings were interviewed. Cox regression analysis showed that cancer survivors who married and were presumed to be at risk of pregnancy were less likely than their sibling controls to have ever begun a pregnancy (relative fertility, 0.85; 95 percent confidence interval, 0.78 to 0.92). Radiation therapy directed below the diaphragm depressed fertility in both sexes by about 25 percent. Chemotherapy with alkylating agents, with or without radiation to sites below the diaphragm, was associated with a fertility deficit of about 60 percent in the men. Among the women, there was no apparent effect of alkylating-agent therapy administered alone (relative fertility, 1.02) and only a moderate fertility deficit when alkylating-agent therapy was combined with radiation below the diaphragm (relative fertility, 0.81). Relative fertility in the survivors varied considerably according to sex, site of cancer, and type of treatment; these factors should be taken into consideration in counseling survivors about the long-term consequences of disease.

Adolescent↗

Cancer in offspring of long-term survivors of childhood and adolescent cancer.

A multicentre retrospective cohort study of long-term survivors of childhood and adolescent cancer identified 7 cases of cancer among 2308 offspring (0.30%) of 2283 case-survivors and 11 cases among 4719 offspring (0.23%) of 3604 controls. Overall, the observed numbers of cases were not significantly different from those expected in the general population. Among offspring of case-survivors observed for the first 5 years of life, the group with the most person-years of follow-up, 5 cancers were reported (3 confirmed), compared with 1.7 expected, a significant excess due mostly to boys whose mothers survived cancer. Some offspring with cancer had known single-gene traits; others resembled previously recognised patterns of family cancer. The remainder may represent chance occurrences or new cancer family syndromes, such as an association with malignant melanoma. The study had an overall 79% power to detect a 3-fold excess of cancer among offspring of case-survivors, but no excess was observed. The number person-years of follow-up in the second decade of life, when most cases of cancer developed, was small.

Adolescent↗

Patterns of nasopharyngeal cancer mortality in the United States.

We examined the geographic pattern of nasopharyngeal cancer (NP cancer) mortality in the United States using economic sub-regions (ESRs) as the basis for analysis. The distribution of 15,145 deaths from NP cancer over the years 1950-1979 revealed clustering in the 119 ESRs that was not detected in analyses of distribution by the 48 states, 506 state economic areas or 3,056 counties or combinations of counties of the coterminous United States. NP cancer mortality among white males was concentrated on the south-east Atlantic and Gulf coasts. This newly described pattern is not due to any recent changes in mortality rates and should provide leads to further epidemiologic study.

Adult↗

Demographic patterns for mesothelioma in the United States.

Incidence rates for pleural and peritoneal mesotheliomas in about 10% of the U.S. population were examined by various demographic characteristics based on 1973-84 data from the Surveillance, Epidemiology, and End Results Program. Although pleural mesothelioma was more common than peritoneal mesothelioma, both are rare diseases in this country. Pleural mesothelioma incidence rates among white males increased over time and were highest in seaboard areas where shipyards have been located (Seattle, San Francisco-Oakland, Hawaii). The significant secular change was attributed to both period (date of diagnosis) and cohort (date of birth) effects. Pleural mesothelioma incidence rates among white males were nearly 50% higher in the 1980-84 period compared to those in 1975-79; the cohort effect rose to a peak for the 1905-9 birth cohort and then declined. These effects probably reflect changes in asbestos exposure patterns in the past and more recent changes in clinical awareness and coding rules for mesothelioma. Geographic analysis of U.S. death certificates for pleural cancer among white males and females dying during 1968-78 indicated that mortality rates were significantly elevated in several areas that have had asbestos-manufacturing plants or shipyards. Analyses of mortality rates must be viewed with caution, since mesothelioma is considerably underreported on death certificates.

Adolescent↗

Recent trends in mesothelioma incidence in the United States.

Mesothelioma incidence rates based on data from population-based cancer registries in New York State (exclusive of New York City), Los Angeles County, California, and the SEER Program of the National Cancer Institute were analyzed for trends, using original cancer registry diagnoses. Results indicate a significant increase in incidence during 1973-80 for pleural mesothelioma among white males older than 55 at time of diagnosis but not for other age-race-sex-site subgroups. A histopathologic review of New York State and Los Angeles County cases by two independent pathologists, expert in the diagnosis of mesothelioma, lowered the overall estimates but a significant upward trend remained. The observed trend does not appear to be related to changes in diagnostic practice. The results of a five-member panel of expert pathologists will be published in a separate methodology paper.

Adolescent↗

Choriocarcinoma incidence in the United States.

To determine the incidence of choriocarcinoma in the United States, the authors examined data from the Surveillance, Epidemiology, and End Results (SEER) Program, 1973-1982, the National Center for Health Statistics, and the Centers for Disease Control. They calculated an overall incidence of one per 24,096 pregnancies or one per 19,920 livebirths. Among whites, who comprised the majority of cases, the incidence was estimated to be one per 22,623 livebirths. After adjustment for age and birth effects, whites demonstrated the lowest rates, with blacks and other races at 2.1- and 1.8 fold elevated risk, respectively. The incidence among whites increased dramatically with maternal age, with women aged 40-44 years at an 8.6-fold excess risk compared with those aged 20-24 years. In addition, teenagers who gave birth were at higher risk. Possible reasons for these incidence patterns are discussed.

Adolescent↗

Burkitt's lymphoma in the USA: cases reported to the American Burkitt Lymphoma Registry compared with population-based incidence and mortality data.

Since 1971, the American Burkitt Lymphoma Registry (ABLR) has been collecting clinical, epidemiological and laboratory data on patients with Burkitt's lymphoma (BL) diagnosed in the USA. Although the 256 confirmed ABLR cases have the advantage of uniform pathological review, the ABLR is a relatively 'passive' registry, with the majority of cases being submitted by interested physicians. To determine the pattern of BL in the USA on a population basis, we analysed incidence and survival data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute (NCI) and mortality data from the National Center for Health Statistics (NCHS). Both SEER and NCHS data demonstrated a more marked predominance of BL in young males than had been found in the ABLR. All three sources of data revealed a broad age spectrum and a relative paucity of cases in the non-white US population. SEER data indicate that the overall incidence of BL in the USA was 1.4 per million for white males and 0.4 per million for white females during 1973-1981. The incidence rate for white males increased over time, perhaps owing to improvements in diagnosis and reporting.

Adolescent↗

Complement-fixing antibody to Epstein-Barr virus soluble antigen in populations at high and low risk for nasopharyngeal carcinoma.

Greenland Eskimos comprise an ethnic group with one of the highest recorded incidence rates for nasopharyngeal carcinoma in the world. Sera from 625 Eskimos and 73 Danes (Caucasians) living in Greenland, as well as from 62 Danes living in Denmark, were tested for complement-fixing antibody to Epstein-Barr virus (EBV) soluble antigen and, from this study group, 129 donors were matched by age and sex for a study comparing antibody to viral capsid antigen, early antigen, and soluble antigen. Both Eskimos and Danes living in Greenland had significantly higher titers of EBV antibodies than Danes living in Denmark, suggesting that environment was more important than genetics or socio-economic factors in determining the antibody response to EBV. Age and sex were also factors, higher titers occurring in females and young Eskimos.

Adolescent↗

The American Burkitt's Lymphoma Registry: eight years' experience.

Four-hundred-twenty-one Americans diagnosed as having Burkitt's lymphoma (BL), 409 from the United States, were studied by the American BL Registry to obtain information about the cause and control of this disease. Of these 421 cases, 256 were confirmed by our pathologists as being morphologically indistinguishable from African BL, A relationship between age and organ involvement was observed; cervical lymph nodes, ileum, and nasopharynx were initial sites of involvement primarily in younger patients. Although the Epstein-Barr virus (EBV) was less frequently associated with American BL than African, a high antibody titer to the EBV capsid antigen was associated with a more favorable prognosis. American BL resembled African BLs time-space clustering, male predominance, and excellent response to chemotherapy. Unlike African BL, however, more patients had involvement of cervical lymph nodes and bone marrow at an early stage of disease. American BL appears to be a more heterogeneous disease than African BL.

Adolescent↗