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PubMedDate not supplied

Cancer statistics for African Americans.

The American Cancer Society provides estimates on the number of new cancer cases and deaths, and compiles health statistics on African Americans in a biennial publication, Cancer Facts and Figures for African Americans. The compiled statistics include cancer incidence, mortality, survival, and lifestyle behaviors using the most recent data on incidence and survival from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program, mortality data from the National Center for Health Statistics (NCHS), and behavioral information from the Behavior Risk Factor Surveillance System (BRFSS), Youth Risk Behavior Surveillance System (YRBSS), and National Health Interview Survey (NHIS). It is estimated that 132,700 new cases of cancer and 63,100 deaths will occur among African Americans in the year 2003. Although African Americans have experienced higher incidence and mortality rates of cancer than whites for many years, incidence rates have declined by 2.7 percent per year in African-American males since 1992, while stabilizing in African-American females. During the same period, death rates declined by 2.1 percent and 0.4 percent per year among African-American males and females, respectively. The decrease in both incidence and death rates from cancer among African-American males was the largest of any racial or ethnic group. Nonetheless, African Americans still carry the highest cancer burden among US racial and ethnic groups. Most cancers detectable by screening are diagnosed at a later stage and survival rates are lower within each stage of disease in African Americans than in whites. The extent to which these disparities reflect unequal access to health care versus other factors is an active area of research.

Adolescent↗
PubMedDate not supplied

Cancer disparities by race/ethnicity and socioeconomic status.

This article highlights disparities in cancer incidence, mortality, and survival in relation to race/ethnicity, and census data on poverty in the county or census tract of residence. The incidence and survival data derive from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) Program; mortality data are from the National Center for Health Statistics (NCHS); data on the prevalence of major cancer risk factors and cancer screening are from the National Health Interview Survey (NHIS) conducted by NCHS. For all cancer sites combined, residents of poorer counties (those with greater than or equal to 20% of the population below the poverty line) have 13% higher death rates from cancer in men and 3% higher rates in women compared with more affluent counties (less than 10% below the poverty line). Differences in cancer survival account for part of this disparity. Among both men and women, five-year survival for all cancers combined is 10 percentage points lower among persons who live in poorer than in more affluent census tracts. Even when census tract poverty rate is accounted for, however, African American, American Indian/Alaskan Native, and Asian/Pacific Islander men and African American and American Indian/Alaskan Native women have lower five-year survival than non-Hispanic Whites. More detailed analyses of selected cancers show large variations in cancer survival by race and ethnicity. Opportunities to reduce cancer disparities exist in prevention (reductions in tobacco use, physical inactivity, and obesity), early detection (mammography, colorectal screening, Pap tests), treatment, and palliative care.

Delivery of Health Care↗
PubMed1993

Risk factors for prostate cancer.

PURPOSE: To review the current state of knowledge regarding risk factors for prostate cancer. DATA SOURCES: Analysis of the literature through the use of MEDLINE as well as identification of papers through review of article bibliographies and the authors' personal files. Current data were also extracted from the Surveillance, Epidemiology, and End Results Program (SEER) database. DATA SELECTION: A review of risk factors for the development of prostate cancer. Emphasis was placed on identifying larger, controlled studies. DATA SYNTHESIS: The clinical incidence of prostate cancer is increasing. Risk factors for prostate cancer appear to include age, race, positive family history, vasectomy, and dietary fat intake. CONCLUSIONS: It appears that prostate cancer results from an interplay between endogenous hormones and environmental influences that include, most prominently, dietary fat.

Aged↗
PubMed1999

Risk for colorectal cancer after gynecologic cancer.

BACKGROUND: Studies have suggested that women with previous diagnoses of gynecologic cancer (cervical, endometrial, or ovarian) have an increased risk for colorectal cancer. OBJECTIVE: To quantify risk for colorectal cancer after gynecologic cancer, both overall and for subgroups defined by age at diagnosis, cancer stage at diagnosis, ethnicity, and duration of follow-up. DESIGN: Retrospective cohort analysis of the Surveillance, Epidemiology, and End Results (SEER) program database from 1974 through 1995. SETTING: U.S. cancer registry. PATIENTS: 21,222 patients with cervical cancer, 51,680 patients with endometrial cancer, and 28,832 patients with ovarian cancer. MEASUREMENTS: Standardized incidence ratios (SIRs) were calculated for each gynecologic cancer site and for subgroups to represent the relative risk for colorectal cancer in women with previously diagnosed gynecologic cancer compared with women without gynecologic cancer. Poisson regression methods adjusting simultaneously for all study variables were used to estimate relative risks for colorectal cancer across subgroups with each gynecologic cancer. RESULTS: Overall, risk for colorectal cancer was elevated among women with previous ovarian cancer (SIR, 1.36 [95% CI, 1.21 to 1.53]). Risk was greatest in women who received a diagnosis before 50 years of age (SIR, 3.67 [CI, 2.74 to 4.80]) but was also elevated in women who received a diagnosis between 50 and 64 years of age (SIR, 1.52 [CI, 1.25 to 1.83]). The risk for colorectal cancer after endometrial cancer was also elevated substantially if endometrial cancer was diagnosed before the age of 50 (SIR, 3.39 [CI, 2.73 to 4.17]). No apparent risk elevation was associated with previous cervical cancer. CONCLUSIONS: Previous endometrial or ovarian cancer, particularly when diagnosed at an early age, increases subsequent risk for colorectal cancer. Greater emphasis on colorectal cancer screening in these populations may be necessary.

Adult↗
PubMed2006

Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation.

BACKGROUND: For BRCA1 or BRCA2 mutation carriers, decision analysis indicates that prophylactic surgery or chemoprevention leads to better survival than surveillance alone. OBJECTIVE: To evaluate the cost-effectiveness of the preventive strategies that are available to unaffected women carrying a single BRCA1 or BRCA2 mutation with high cancer penetrance. DESIGN: Markov modeling with Monte Carlo simulations and probabilistic sensitivity analyses. DATA SOURCES: Breast and ovarian cancer incidence and mortality rates, preference ratings, and costs derived from the literature; the Surveillance, Epidemiology, and End Results (SEER) Program; and the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services). TARGET POPULATION: Unaffected carriers of a single BRCA1 or BRCA2 mutation 35 to 50 years of age. TIME HORIZON: Lifetime. PERSPECTIVE: Health policy, societal. INTERVENTIONS: Tamoxifen, oral contraceptives, bilateral salpingo-oophorectomy, mastectomy, both surgeries, or surveillance. OUTCOME MEASURES: Cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: For mutation carriers 35 years of age, both surgeries (prophylactic bilateral mastectomy and oophorectomy) had an incremental cost-effectiveness ratio over oophorectomy alone of 2352 dollars per life-year for BRCA1 and 100 dollars per life-year for BRCA2. With quality adjustment, oophorectomy dominated all other strategies for BRCA1 and had an incremental cost-effectiveness ratio of 2281 dollars per life-year for BRCA2. RESULTS OF SENSITIVITY ANALYSIS: Older age at intervention increased the cost-effectiveness of prophylactic mastectomy for BRCA1 mutation carriers to 73,755 dollars per life-year. Varying the penetrance, mortality rates, costs, discount rates, and preferences had minimal effects on outcomes. LIMITATIONS: Results are dependent on the accuracy of model assumptions. CONCLUSION: On the basis of this model, the most cost-effective strategies for BRCA mutation carriers, with and without quality adjustment, were oophorectomy alone and oophorectomy and mastectomy, respectively.

Adult↗
PubMed1999

Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma.

BACKGROUND: A National Institutes of Health (NIH) Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma, held in June 1990, recommended breast conservation therapy for the majority of women with Stage I or II breast carcinoma. The authors evaluated the national use of breast conservation therapy before and after the conference to determine whether the conference had had an impact on utilization. METHODS: Women with Stage I or II breast carcinoma (n = 109,880), diagnosed during the years 1983-1995, were identified via 9 population-based cancer registries of the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. The likelihood of breast conservation surgery versus mastectomy and, among women who underwent breast conservation surgery, the likelihood of postoperative radiation therapy versus none, were assessed for 3 time periods (January 1983 to April 1985, May 1985 to June 1990, and July 1990 to December 1995). Associations between the use of breast conservation surgery or postoperative radiotherapy according to patient stage, age, race, and region were compared among women diagnosed before and after the NIH Consensus Development Conference. RESULTS: From 1985 (the year that the U.S. randomized controlled trial demonstrating equivalent efficacy between breast conservation therapy and mastectomy was published) through 1989, approximately 35% of women with Stage I and 19% of women with Stage II breast carcinoma underwent breast conservation surgery; these percentages remained constant throughout this period. Beginning in 1990, the year of the NIH Consensus Development Conference, the use of breast conservation surgery increased in each subsequent year; by 1995, 60% of women with Stage I and 39% of women with Stage II breast carcinoma received such treatment. However, regional variation in use was observed (Stage I, range 41.4-71.4% for 1995) and no registry reported breast conservation therapy for the majority of women with Stage II disease (range, 23.8-48.0%). The use of postoperative radiotherapy for women who underwent breast conservation surgery was similar in the periods before and after the conference. CONCLUSIONS: Although breast conservation therapy was performed more frequently following the NIH Consensus Development Conference, variation in use by region of the U.S. suggests the continued presence of barriers to widespread adoption of the recommendations formulated at the conference.

Adult↗
PubMed2000

Should we colonoscope women with gynecologic cancer?

Retrospective analysis of the Surveillance Epidemiology and End Results (SEER) program database for the period 1974 through 1995 identified 101,734 white and African-American women, age > or = 25 yr, with prior cervical, endometrial, or ovarian cancer. Subsequent follow-up demonstrated no increased risk of colorectal cancer in women with cervical cancer. For endometrial cancer patients, increased risk of colorectal cancer was confined to women whose diagnosis of endometrial cancer was before age 50, but the increased risk was substantial in this group (RR 3.39; 95% CI 2.73-4.17). For ovarian cancer patients, increased risk for colorectal cancer was substantial for those diagnosed with ovarian cancer before age 50 (RR 3.67; 95% CI 2.74-4.80), and there was some increased risk for women diagnosed at ages 50-64 yr (RR 1.52; 95% CI 1.25-1.83).

Adult↗
PubMed2000

Changing incidence rate of invasive lobular breast carcinoma among older women.

BACKGROUND: In 1998, an unusually large number of invasive lobular breast carcinoma cases were seen at the University of Washington. The purpose of this study was to assess whether the incidence rate of invasive lobular carcinoma has been increasing disproportionately compared with the incidence rate of invasive ductal carcinoma. METHODS: Age specific and age-adjusted breast carcinoma incidence rates from 1977-1995 were obtained from the nine population-based cancer registries that participate in the Surveillance, Epidemiology, and End Results (SEER) program. Three histologic groupings were used: lobular, ductal, and all invasive breast carcinomas. Overall incidence rates for each grouping, as well as for each stage (local, regional, and distant), were obtained. RESULTS: The rate of incidence of lobular carcinoma increased steadily from 1977-1995 in women age >/= 50 years whereas it remained stable in women age < 50 years. Alternatively, the rate of incidence of ductal carcinoma increased steadily from 1977-1987, but from 1987-1995 it remained relatively constant across all age groups. CONCLUSIONS: The incidence rates of invasive lobular breast carcinomas increased steadily since 1977 whereas the incidence rates of invasive ductal carcinoma have plateaued since 1987. This rise occurred specifically among women age >/= 50 years and may be related to postmenopausal status. Further epidemiologic, clinical, and laboratory research is required to assess what factors are contributing to this trend.

Adult↗
PubMed2000

Characteristics of cancer patients under age 20 at a population-based registry, Puerto Rico, 1980-1991.

OBJECTIVES: To evaluate and describe the characteristics and incidence of pediatric (< 20 years) cancer in Puerto Rico between 1980-1991. METHODS: A descriptive study of all new childhood cancer cases among residents of Puerto Rico reported to the Cancer Registry between the years 1980 and 1991 was conducted. The distribution of cases was described by age, gender, place of residence, histology, last date known to be alive, and stage of disease. Incidence rates and standardized incidence rates by age were calculated. RESULTS: A total of 1,823 new pediatric cases were reported from 1980 through 1991. Over half were males, and 52.2% were aged < 10 years. Most cases resided in urban areas. The most frequent histologic types were leukemia (31.0%), lymphomas and other reticulo-endothelial neoplasms (16.2%), and brain, central nervous system, and intracranial and intraspinal neoplasms (16.0%). The most frequent type of tumor was acute lymphocytic leukemia (22.0%). Although the overall distribution of most neoplasms was similar between genders, a higher proportion of lymphomas was reported among males, and there were significantly more carcinomas among girls. The largest increase in the age-adjusted incidence rate between periods (1980-84 and 1985-89) occurred in the 5-9 age group. CONCLUSIONS: Overall, these findings are consistent with previous studies in USA. However, there were some differences in the distribution of histologic types when compared with similar studies in other countries, and with the results of the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Factors such as differences in diagnostic capabilities among countries must be taken into consideration.

Adolescent↗
PubMedDate not supplied

Adherence to care plan in women with abnormal Papanicolaou smears: a review of barriers and interventions.

BACKGROUND: Cancer of the cervix is preventable. According to the Surveillance, Epidemiology, and End Results (SEER) Program, invasive cervical cancer incidence is 9.0 and cancer mortality rate is 2.8 per 100,000 persons. Effective prevention includes appropriate use of Papanicolaou smears and adherence to a care plan by the patient. This review will examine the extent of nonadherence, negative outcomes, barriers, and interventions for improved adherence to care. METHODS: Computer searches in MEDLINE for English language articles were conducted from 1968 to 1999 using the key words "colposcopy," "abnormal Papanicolaou smear," "patient compliance," "adherence to care," and "follow-up." RESULTS: Although there is 10% to 40% nonadherence in the studies reviewed, the definition of nonadherence is not standard. Considerable morbidity from cervical cancer was described among nonadherent women. The most common barriers to follow-up were lack of understanding of the purpose of colposcopy, fear of cancer, forgetting appointments, and lack of time, money, or childcare. Emotional consequences of abnormal Papanicolaou smears had considerable impact on follow-up visits. Focused intervention strategies targeted to the study population were most effective in improving adherence. CONCLUSIONS: Nonadherence results from the interplay of emotional, logistic, cultural, or socioeconomic factors. Among the most effective strategies to improve adherence are personalized reminders to patients by their primary physicians and case management dictated by the size, structure, and style of the practice.

Case Management↗
PubMed2002

Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older.

Numerous studies have demonstrated differences in certain biological breast cancer characteristics associated with survival, including hormone receptor status and histology, among women of different racial and ethnic groups. However, women classified as "Asian or Pacific Islanders" or "Hispanic whites" represent heterogeneous populations, and few studies have separately evaluated subgroups of these populations with respect to these breast tumor characteristics. Using data obtained from 11 cancer registries that participate in the Surveillance, Epidemiology, and End Results (SEER) Program, the tumor characteristics of 93,317 women in whom invasive breast cancer was diagnosed from 1992 to 1998 were compared by race and ethnicity using unconditional and polytomous logistic regression. The study consisted of 75,978 non-Hispanic whites, 6,915 African Americans, 203 Native Americans, 5,750 Asians/Pacific Islanders, and 4,471 Hispanic whites. Eight Asian/Pacific Islander and four Hispanic white subgroups were also analyzed separately. Relative to non-Hispanic whites, African Americans, Native Americans, Filipinos, Chinese, Koreans, Vietnamese, Indians/Pakistanis, Mexicans, South/Central Americans, and Puerto Ricans living in the United States had 1.4- to 3.1-fold elevated risks of presenting with estrogen receptor-negative/progesterone receptor-negative breast cancer. Numerous differences by histological type, including lobular, ductal/lobular, mucinous, comedocarcinoma, tubular, and medullary histologies, were also observed by race/ethnicity. Breast cancer tumor characteristics differ by race/ethnicity in the United States. Both biological and lifestyle factors likely contribute to these findings. Our results may explain, to some extent, the differences in breast cancer stage and survival observed by race/ethnicity. Understanding the factors underlying these differences may provide further insight into breast cancer etiology in different populations.

Age Distribution↗
PubMedDate not supplied

Risk of primary non-hepatocellular malignancies in hereditary hemochromatosis.

OBJECTIVE: The relationship between hemochromatosis, a genetic iron disorder, and the risk of hepatocellular carcinoma is well-documented. However, the true incidence of non-hepatocellular malignancies remains ill defined. We performed a retrospective cohort study to identify a possible association between hereditary hemochromatosis and the development of non-hepatocellular carcinomas. MATERIALS AND METHODS: After appropriate institutional review board approval, an extensive chart review was completed on all patients with hereditary hemochromatosis diagnosed between 1986 and 2001. The diagnosis was based on either a genetic study to identify the Cys282Tyr and the His63Asp mutations on the HLA-H gene and/or hepatic tissue diagnosis, in conjunction with a treatment history of therapeutic phlebotomy. Data collection also included documentation of associated malignancies, the presence of co-morbid medical illnesses, and risk factors for cancer. Our database was age-standardized to the United States population using the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program data to obtain a standardized incidence ratio (SIR) of non-hepatocellular malignancies in our study population. RESULTS: Fifty-nine patients (49 males, 10 females) with a mean age of 46 years (range: 10-68 years) met the criteria for the diagnosis of hereditary hemochromatosis. Of these, 13 patients (22%) had a biopsy-proven diagnosis of a primary non-hepatocellular malignancy giving an age-adjusted SIR of 1.40 (p < 0.04). Histologically, the types of malignancy included: 3 patients with colorectal cancer; 2 patients with gastric carcinoma, 3 patients with prostate cancer; 2 patients with breast cancer; 1 patient with acute myelogenous leukemia, one patient with Hodgkin's lymphoma and one patient with non-Hodgkin's lymphoma. CONCLUSION: While an association between hemochromatosis and hepatocellular carcinoma is well-described, there also appears to be a relationship between hemochromatosis and the development of non-hepatocellular malignancies. Since increased iron stores alone have not been proven to be premalignant in recent studies, interplay between genetic factors in hemochromatosis may play a role as a risk factor in the development of an associated malignancy. Larger cohorts of subjects with hereditary iron overload disorders are needed to confirm our findings. Furthermore, if a causal association between hemochromatosis and common carcinomas does indeed exist, such patients may be candidates for individualized, rigorous cancer screening programs.

Adolescent↗
PubMedDate not supplied

Differences in histology between first and second primary lung cancer.

Data from the Surveillance, Epidemiology, and End Results (SEER) Program were used to compare the histological distribution of second lung cancer following an initial cancer of the lung, head and neck, and breast to primary lung carcinoma occurring as a first cancer. Following initial head and neck cancer or initial squamous cell carcinoma of the lung, the proportion of second primary lung cancer which was of squamous cell histology rose dramatically, while the proportion of pulmonary adenocarcinomas rose following initial adenocarcinoma of the lung. The histological distribution of lung cancer following an initial breast cancer in women was similar to the distribution of de novo lung cancer in women. These results persisted as the time interval between diagnosis of the two primaries was increased from 12 to 48 months. We conclude that the histology of a second primary lung cancer following an initial cancer of the lung or head and neck tends to repeat the histology of the initial cancer (field effect), and this observation is not likely to be due to misdiagnosis of a recurrence of the initial cancer.

Adenocarcinoma↗
PubMed1992

Comorbidity and functional status in older women with breast cancer: implications for screening, treatment, and prognosis.

This is a review of research on the effects of comorbidity and functional status on breast cancer diagnosis, treatment, and prognosis in older women. The objective is to summarize results from recent studies and recommend directions for future research (a) to develop more precise guidelines for breast cancer screening, and (b) to identify and eliminate barriers preventing the attainment of those guidelines. Research is needed to determine more clearly how comorbidity and functioning affect screening practices and stage of disease at diagnosis. There is evidence that comorbidity explains, in part, why older women receive less invasive therapy. It is unknown, however, whether these treatment decisions improve quality or duration of survival. Although it is evident that comorbidity and disability adversely affect survival, research is needed to examine the etiology, course, and effects of specific combinations of conditions. Final recommendations include using the Established Populations for Epidemiologic Studies of the Elderly (EPESE) and the Surveillance, Epidemiology, and End Results (SEER) programs to address a number of these questions.

Aged↗
PubMedDate not supplied

Comparison of bladder cancer survival among Japanese, Chinese, Filipino, Hawaiian and Caucasian populations in the United States.

BACKGROUND: Racial differences for bladder cancer survival have been reported for Caucasians and African-Americans. However, the survival experience of bladder cancer patients in Asian and Pacific Islander ethnic groups in the United States have not been fully explored. The purpose of this study was to compare the bladder cancer survival rates of Japanese, Chinese, Filipinos, Hawaiians and Caucasians in the U.S. population. MATERIALS AND METHODS: The data was from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute between 1973 and 1998. Cox proportional hazard models and Kaplan-Meier's estimates were used to study differences in survival between the ethnic groups, adjusting for factors including age at diagnosis, gender, year of diagnosis, histological grade, stage, surgery type, and radiation therapy. RESULTS: The overall bladder cancer survival was 66% for Japanese patients, 64% for Chinese patients, 61% for Caucasians, 59% for Filipino patients and 52% for Hawaiian patients. Differences in bladder cancer survival rates between Japanese and Chinese populations in the United States were not observed. In the Asian population, higher relative risks and lower 5-year survival were observed with increasing age at diagnosis (p for trend<0.0001), grade (p for trend<0.0001), and stage (p for trend<0.0001). Asian women had lower survival and a higher risk of death due to bladder cancer than Asian men. CONCLUSIONS: Japanese and Chinese bladder cancer patients had higher overall survival rates than Caucasians, while Filipino and Hawaiian patients had lower survival than Caucasians.

Age Factors↗
PubMed2003

Racial disparities in cancer incidence and mortality: Wisconsin and United States, 1996-2000.

These findings focus on African American-white disparities in cancer incidence and mortality between 1996 and 2000 in Wisconsin and the United States. Cancer incidence data were obtained from the Wisconsin Cancer Reporting System (WCRS), the National Cancer Institute's (NCI) Surveillance, Epidemiology and End Results (SEER) Program, and mortality data from the National Center for Health Statistics. Results of this study highlight site-specific differences in cancer incidence and mortality rates age adjusted to the 2000 US standard population. Incidence and mortality rate ratios (RR) were calculated comparing African American and white populations. Supplemental variables of cancer-related risk behaviors from the Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) and stage of disease at diagnosis information from WCRS were also examined for differences between African American and white populations. Results showed Wisconsin had an overall greater disparity than the United States for all cancers combined and for cancers of the lung, cervix, and gastrointestinal sites. During the 5-year period, Wisconsin's overall cancer mortality rate was 196 per 100,000, but among African Americans in Wisconsin, the overall mortality rate was 272 per 100,000.

Black People↗
PubMed1992

Breast and cervical cancer surveillance, United States, 1973-1987.

Breast and cervical cancer incidence and mortality rates were reviewed for the period 1973-1987. For breast cancer, mortality has been relatively stable, increasing from 26.9/100,000 women in 1973 to 27.1 in 1987. Alternatively, data from the National Cancer Institute's Surveillance, Epidemiology, End Results Program (SEER) showed a 36% increase in the incidence of this malignancy over the same period. In 1987, overall incidence of invasive breast cancer was 111.9/100,000 women. White women experienced lower overall mortality rates and higher overall incidence than black women; however, these differences varied by age. Examination of breast cancer incidence by stage of disease at diagnosis revealed that rates for distant and regional disease have remained relatively stable since 1973. In contrast, rates of localized and in situ cancers exhibited an increase in the 1980s that may correspond to increased use of mammography in this country. The rate of decline in cervical cancer incidence and mortality has slowed in recent years. In 1987, 3.0 cervical cancer deaths/100,000 women occurred. SEER incidence for invasive disease for that year was 8.2/100,000. Rates varied by race, age, state, and stage of disease. In general, black women experienced much higher incidence and mortality from invasive cervical cancer than white women. For both races, rates of in situ disease were highest among young women and decreased rapidly with age. Rates of in situ cervical cancer were consistently higher than rates of invasive cancer for the time period studied.

Adult↗
PubMedDate not supplied

Breast cancer in young women: case report and a review.

BACKGROUND: Breast cancer in patients under 40 years is uncommon. Surveillance, Epidemiology and End Results (SEER) program reveals that 75% of breast tumors occur in women age > 50 years, only 6.5% in women age < 40 years, and a mere 0.6% in women age < 30 years. Breast-conserving surgery with subsequent chemo-radiotherapy has become the treatment of choice in women with breast neoplasm. CASE REPORT: Two young patients, 30 and 28 years respectively, with breast cancer. One patient with an atypical medullary breast carcinoma diagnosis, pT2 pN1 bipMx, Grade 3 Stage IIB, negative for receptors, Ki 67: 47%, cERB-2 negative; the other with an intraductal breast carcinoma, pT1c pN0 pMx, Grade 2 Stage I, negative for receptors, Ki 67: 85%, cERB-2 negative, p53 negative, Bcl-2 negative. The first patient underwent right radical mastectomy sec. Madden and axillary lymphoadenectomy in October 2001, started six cycles of adjuvant chemotherapy and radiotherapy on the right side of the chest and on axillary and supraclavicular lymph nodes area. After 2 years an ecotomography revealed small hypoechogenic nodules in the left breast. In December the patient underwent left radical mastectomy with positioning of an expander device. The histological exam revealed a not much differentiated intraductal carcinoma, pT1a N0 Mx, Stage I. After the surgical therapy, she follows another adjuvant chemotherapy. The second patient underwent left quadrantectomy with axillary limphoadenectomy in November 2004. Like the first-will follow several cycles of adjuvant chemotherapy and radiotherapy. DISCUSSION: Breast cancer in women under 40 years of age differ from breast cancer in older women in numerous clinical, pathological and biological features. The studies demonstrate that breast cancer arising in women under 40 years have a more aggressive profile than those of older patients. In both our patients family history of breast cancer was reported. That suggests a possible genetic susceptibility of these patients through BRCA1 and BRCA2 germ-line mutations. Breast conservative surgery with chemio-radiotherapy is the most commonly used treatment breast cancer, expecially in consideration of the aggressiveness of the lesions.

Adult↗