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PubMed2006

Influence of patterns of hormone replacement therapy use and mammographic density on breast cancer detection.

BACKGROUND: There is evidence that factors such as current hormone replacement therapy (HRT) use and mammographic density may each lower the sensitivity of mammography and are associated with a greater risk of developing an interval cancer. This study explores this relationship further by examining the influence of patterns of HRT use and the percentage of mammographic density on the detection of breast cancer by classification of interval cancer. METHODS: This study uses a case-case design nested within a cohort of women screened by the Ontario Breast Screening Program between 1994 and 2002. Interval cancers, both those missed at screening but seen on retrospective review (n = 87) or true intervals without visible tumor signs at screening (n = 288) were matched to 450 screen-detected cancers. The association between the percentage of mammographic density, measured by radiologists and a computer-assisted method, and HRT use, ascertained from a mailed questionnaire, and the risk of being diagnosed with an interval cancer was estimated using conditional logistic regression. RESULTS: A monotonic gradient of increasing risk for interval cancers was found for each 25% increase in mammographic density [odds ratio (OR), 1.77; 95% confidence intervals (95% CI), 1.07-2.95 for missed intervals and OR, 2.16; 95% CI, 1.59-2.94 for true intervals]. After adjusting for mammographic density, a significantly increased risk for true-interval cancers remained for women taking estrogen alone (OR, 1.75; 95% CI, 1.11-2.83) as well as for missed- (OR, 2.84; 95% CI, 1.32-6.13) and true-interval cancers (OR, 1.79; 95% CI, 1.10-2.90) for women taking combined HRT. CONCLUSIONS: Information on mammographic density and HRT use should routinely be collected at the time of screening. Women at risk should be made aware of the lower sensitivity of mammography and offered alternative procedures for screening.

Aged↗
PubMed2000

Bone marrow micrometastases and gastrointestinal cancer detection and significance.

Accurate staging of cancer is important, as the presence or absence of systemic spread determines treatment. The sensitivity of current imaging and biochemical techniques is suboptimal for the detection of minimal residual disease and latent metastases. This results in understaging and potential undertreatment. To improve detection of disseminated epithelial malignancy, immunohistochemical and molecular methods have been employed that search for epithelial cell-specific proteins in nonepithelial tissue. Bone marrow is mesenchymal tissue (that does not normally express epithelial cell components) and represents an accessible window for detection of micrometastatic carcinoma cells. Detection methods for epithelial cell components (cytokeratins, epithelial membrane antigen, carcinoembryonic antigen) include immunohistochemistry, flow cytometry, reverse transcriptase polymerase chain reaction (rt-PCR), and enzyme linked immunoassay (ELISA). Micrometastatic cells in bone marrow are viable, capable of proliferation, resistant to immune attack, and insensitive to s-phase chemotherapeutic agents. Patients with carcinomas of the lung, breast, prostate, or gastrointestinal tract and in whom bone marrow micrometastases are detected have a foreshortened interval to recurrence and impaired survival. Detection of micrometastases deserves serious consideration in treatment protocols, and standardization of methods is now required.

Bone Marrow Neoplasms↗
PubMed2004

A side by side comparison of cytology and biomarkers for bladder cancer detection.

PURPOSE: The identification of accurate bladder tumor markers/tests could improve diagnosis, recurrence monitoring and treatment in patients with bladder cancer. In this study we compared the efficacy of the hyaluronic acid (HA)-hyaluronidase (HAase), BTA-Stat (Bard/Bion Diagnostics, Redmond, Washington), Hemastix (Bayer Corp., Elkhart, Indiana) (hematuria detection) and UBC-Rapid (IDL Biotech, Borlänger, Sweden) tests, and cytology to detect bladder cancer. The HA-HAase test measures urinary HA and HAase levels, BTA-Stat detects complement factor-H and H related protein in urine, the Hemastix hemoglobin dipstick detects hematuria and UBC-Rapid detects cytokeratin 8 and 18 fragments in urine. MATERIALS AND METHODS: A total of 138 urine specimens from 115 patients were collected at University Hospital Hamburg-Eppendorf, including 59 with active bladder cancer and 79 with a history of bladder cancer (73) or with benign genitourinary conditions (6). Specimens were assayed by the HA-HAase test, BTA-Stat, Hemastix (hemoglobin dipstick) and UBC-Rapid. Cystoscopy and histological findings were used to make the clinical diagnosis. Cytology results were available on 92 patients. RESULTS: In a side by side comparison the HA-HAase test, cytology, BTA-Stat, Hemastix and UBC-Rapid had 88.1%, 70.6%, 52.5%, 50.8% and 35.6% sensitivity, and 81%, 81%, 76.7%, 78.2% and 75% specificity, respectively. The accuracy, and negative and positive predictive values of the HA-HAase test were the highest (84.1%, 90.1% and 77.6%), followed by cytology (77.2%, 82.5% and 68.6%), Hemastix (66.4%, 67.8% and 63.8%), BTA-Stat (66.2%, 67.8% and 63.3%) and UBC-Rapid (57.8%, 60% and 52.5%), respectively. CONCLUSIONS: : The HA-HAase test is superior to cytology, BTA-Stat, Hemastix and UBC-Rapid for detecting bladder cancer recurrence. A side-by-side comparison of tumor markers should help identify a marker for monitoring bladder cancer recurrence.

Adult↗
PubMed1989

Cancer detection and the community pharmacist.

A questionnaire was prepared to asses community pharmacists' perceptions of their abilities to recognize the common signs and symptoms of cancer and their preferred methods for obtaining further education. Of 5,539 questionnaires mailed, 1,187 were returned and analyzed. Seventy percent of the pharmacists reported that at least one patient per month sought advice about possible cancer signs and symptoms. Almost half estimated that between 1% and 25% of the patients who had sought advice for these cancer signs and symptoms had attempted to purchase a medication to treat these symptoms. The vast majority of the pharmacists perceived that they could recognize common signs and symptoms of skin, breast, and colorectal cancers. However, the majority felt they could not identify the symptomatology for six other common cancers. Essentially all pharmacists rated education in cancer symptomatology to be important. There was no consensus as to the type of provider, format, or times for this continuing education. These data suggest that pharmacists can play an important role in the early detection and prevention of cancer. The rate of interaction by pharmacists in this study translates to more than 60,000 patients counseled about cancer symptoms per 1,000 pharmacists per year. Further education of the pharmacist in cancer detection is warranted, and appraisal of the outcome of such educational interventions on patient-referral patterns and cancer-related diagnoses is imperative.

California↗
PubMed2005

Apoptotic regulators in prostatic intraepithelial neoplasia (PIN): value in prostate cancer detection and prevention.

Early diagnosis of prostate cancer holds tremendous promise for the effective therapy and impact on survival of prostate cancer patients. High-grade prostatic intraepithelial neoplasia (HGPIN) is generally accepted as a lesion indicative of a late pathological event in the premalignant changes leading to full development of prostate cancer. This review seeks to identify specific molecular events that may be linked directly to the molecular transition from benign prostate epithelial cells to prostate carcinoma. HGPIN is pathologically detected in a limited group of men undergoing prostate cancer screening for an elevated serum prostate-specific antigen (PSA) or abnormal digital rectal examination (DRE). Loss of apoptotic control provides a molecular basis for the contribution of specific defective steps in the pathway towards development and progression of prostate cancer. Comparative dissection of the apoptosis status and expression profile of key apoptotic regulators among foci of highly proliferative benign prostatic epithelium, PIN and prostate adenocarcinoma from adjacent areas of the same gland revealed a novel insight into the dysfunctional apoptosis events contributing to prostate carcinogenesis. The sequential and notable loss of the three critical signaling components of the apoptotic action of transforming growth factor-beta (TGF-beta), in the prostate, that is, the transmembrane receptor II (TbetaRII), the key cell cycle inhibitor p27(Kip1), as well as the protagonist downstream effector of the TGF-beta signaling mechanism, Smad4, points to their potential value to 'faithfully' characterize HGPIN, as a premalignant prostate lesion. Recent evidence on the molecular changes in apoptosis regulators contributing to HGPIN and their role as molecular markers of disease onset, as well as candidates for therapeutic targeting/chemoprevention of prostate cancer in its early stages will be discussed.

Adenocarcinoma↗
PubMed2006

Silent urothelial cancer detected by sonography after renal transplantation.

OBJECTIVES: Organ transplantation increases the incidence of cancer through unclear mechanisms. In our observation, urothelial cancer happens much more frequently in Chinese people. We reviewed the detection of urothelial cancer in our series after renal transplantation. METHODS: From July 1981 to June 2005, we performed 620 renal transplantations. We do graft and native kidney sonography survey annually even if the patient is asymptomatic. During this period, 10 urothelial tumors were detected. Herein we have reviewed the findings in these cases, along with their management and outcomes. RESULTS: Moderate to severe hydronephrosis of native kidneys was observed in 14 patients, including 9 (64.3%) who had cancer including eight asymptomatic and only one with flank pain and lymph nodes metastasis succumbing in 10 months with a functioning graft. Three patients showed similar degrees of graft hydronephrosis and graft ureteral cancer was diagnosed in one. Mean time from transplantation was 5.09 years. There was a female predominance (7:3). The bladder-to-renal pelvis-to-ureter ratio was 2:5:7, which was distinct from the usual 51:3:1 distribution. In native ureter cancer, we found the left ureter more prone to develop cancer than the right (8:1). CONCLUSION: The pattern of cancer in renal transplant patients is thoroughly different from the general population, namely female predominance, with a higher incidence of ureteral and renal pelvis versus bladder cancer. In our observation, routine periodic sonography survey even in asymptomatic patients is important for urothelial tumor detection, as the incidence of cancer is surprisingly high.

Female↗
PubMed2000

Genetic changes in breast cancer detected by comparative genomic hybridisation.

Breast cancer is characterised by a number of genetic aberrations. Our purpose was to use comparative genomic hybridisation (CGH) to screen breast carcinomas for copy number changes: 44 ductal and 8 lobular carcinomas were studied and a large number of genetic aberrations identified. Many of these showed similarity to previous CGH results, however, a number of loci not previously shown to have undergone frequent change were identified. This included copy number gains affecting chromosomes 1p, 4q, 5q, 6q and 13q. Furthermore, we have identified 2 regions of copy number change, the gain on 5p and deletion of 16q, which correlated with lobular carcinomas. Our results highlight several areas of the genome that may be important in the molecular genetics of breast cancer.

Adult↗
PubMed2004

Data mining techniques for cancer detection using serum proteomic profiling.

OBJECTIVE: Pathological changes in an organ or tissue may be reflected in proteomic patterns in serum. It is possible that unique serum proteomic patterns could be used to discriminate cancer samples from non-cancer ones. Due to the complexity of proteomic profiling, a higher order analysis such as data mining is needed to uncover the differences in complex proteomic patterns. The objectives of this paper are (1) to briefly review the application of data mining techniques in proteomics for cancer detection/diagnosis; (2) to explore a novel analytic method with different feature selection methods; (3) to compare the results obtained on different datasets and that reported by Petricoin et al. in terms of detection performance and selected proteomic patterns. METHODS AND MATERIAL: Three serum SELDI MS data sets were used in this research to identify serum proteomic patterns that distinguish the serum of ovarian cancer cases from non-cancer controls. A support vector machine-based method is applied in this study, in which statistical testing and genetic algorithm-based methods are used for feature selection respectively. Leave-one-out cross validation with receiver operating characteristic (ROC) curve is used for evaluation and comparison of cancer detection performance. RESULTS AND CONCLUSIONS: The results showed that (1) data mining techniques can be successfully applied to ovarian cancer detection with a reasonably high performance; (2) the classification using features selected by the genetic algorithm consistently outperformed those selected by statistical testing in terms of accuracy and robustness; (3) the discriminatory features (proteomic patterns) can be very different from one selection method to another. In other words, the pattern selection and its classification efficiency are highly classifier dependent. Therefore, when using data mining techniques, the discrimination of cancer from normal does not depend solely upon the identity and origination of cancer-related proteins.

Biomarkers, Tumor↗
PubMed2004

Elapsed time from breast cancer detection to first adjuvant therapy in a Canadian province, 1999-2000.

BACKGROUND: A number of studies have examined time intervals between care steps in breast cancer diagnosis and treatment. The objective of this study was to document the elapsed time from first clinical or mammographic detection of breast abnormality to initiation of first adjuvant therapy in women with invasive breast cancer in Nova Scotia and to examine the effect of age, disease stage and place of residence on these intervals. METHODS: All dates were abstracted from patient charts and the Oncology Patient Information System. Eligible women were those with invasive breast cancer detected by Sept. 1, 1999, who were referred to 1 of 2 provincial cancer treatment centres by Sept. 1, 2000. All time intervals were calculated in days, and only patients experiencing both care events defining an interval were included in the analysis of time to event for that interval. We used proportional hazards regression analysis to evaluate the influence of patient age, disease stage and place of residence on times between care events. RESULTS: A total of 776 new diagnoses of breast cancer were reported to the Nova Scotia Cancer Registry over the study period. Of the 776, 467 met the inclusion criteria, and 364 patients were eligible for analysis. The overall median time from clinical or mammographic detection of breast cancer to initiation of first adjuvant therapy was 91 days (interquartile range 72-123 days). Disease stage was the strongest predictor of elapsed time: the median interval from disease detection to initiation of first adjuvant therapy for patients with stage I disease was 118 days, as compared with 85 days for those with stage II disease and 75 days for those with stage III disease (adjusted hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.6-2.8). Patients aged 70 years or more at diagnosis experienced longer elapsed times (median interval 98 days) than did younger patients (93 days for those aged 50-69 years and 82 days for those aged 49 years or less) (adjusted HR 1.6, 95% CI 1.1-2.4). INTERPRETATION: Women aged 70 or more and those with stage I breast cancer experienced longer elapsed times from disease detection to initiation of first adjuvant therapy than did younger women and those with more advanced disease. These findings may have implications for the design of interventions to minimize intervals between steps in breast cancer care and should be validated within the Canadian context. Future investigation exploring the full spectrum of breast cancer care may lead to a more complete understanding of processes and gaps in the current system.

Aged↗
PubMed2000

[Analysis of a program of early breast cancer detection in a rural area].

OBJECTIVE: To find the results of a breast cancer early-detection programme run in a rural area, in terms of the activities corresponding to primary care. DESIGN: Cross-sectional, observational study. SETTING: Rural district in Primary Care Area 11, Madrid. The programme was run in this area between 1st February and 31st March 1999. PATIENTS: Women from 50 to 64, both inclusive, who had been called for a mammography. INTERVENTIONS: Inclusion in the breast cancer early-detection programme and open telephone survey of those who did not take part to find the reasons for not taking part in the randomised sample. MEASUREMENTS AND MAIN RESULTS: In the period mentioned, 3902 women were called for screening (60.07% of all women between 50 and 64. The rest will be called in a second round in the year 2000). 2099 women attended for mammography (participation index 53.79%), with the following results: 5 (0.24%) highly likely to be malignant; 6 (0.29%) probably malignant; 172 (8.19%) probably benign; 1393 (66.36%) found to be benign; 438 (20.87%) negative; and 85 (4.05%) who needed further evaluation. The main reasons why 46.21% of the women called did not attend for mammography were: they had had one recently (29.9%); could not attend (22.7%); did not want to have one (17.5%); had not received the notification (17.5%). CONCLUSIONS: The participation rate was acceptable, with fewer malignant cases found than in other programmes. It would be important to call again those women who could not attend.

Breast Neoplasms↗
PubMed1997

Low level c-myc gene amplification in gastric cancer detected by dual color fluorescence in situ hybridization analysis.

BACKGROUND AND OBJECTIVES: By using the dual color fluorescence in situ hybridization analysis, the amplification of c-myc gene can be detected in the tumor tissue samples obtained from patients with gastric cancer, and the relationship between the molecular cytogenetic change and the clinical stage or histological type may be clarified. METHOD: The tumor tissue samples were obtained from 21 patients with gastric cancer. Simultaneous detection of signals from the chromosome 8 centromere and c-myc gene in each cell after hybridization with appropriate probes was carried out on 50-200 tumor cells in each case. RESULTS: Chromosome 8 polysomy was found in 10 patients. The average centromere 8 copy number was significantly higher in differentiated (2.7) than in undifferentiated (2.3) types of gastric cancer. However, there was no significant difference in occurrence of polysomy 8 between early and advanced cancer. The relative gain (1.1-1.9) of c-myc copy number was found in all 21 cases. There was no significant difference in the fraction of cells with c-myc gene amplification between early (pT1) and advanced (pT2-4) carcinomas. CONCLUSION: We conclude that the present dual color fluorescence in situ hybridization of gastric cancer may be useful in the evaluation of low level c-myc gene amplification, which is difficult to detect by Southern blotting, and may be applicable to the diagnosis of early gastric cancer.

Adult↗
PubMed1995

Determinants of breast cancer detection among Wisconsin (United States) women, 1988-90.

Early detection is advocated widely as the best method to reduce the high rate of breast cancer mortality in women. The purpose of this study was to describe the detection histories of women with breast cancer and to identify factors related to the method of detection. During the period 1988-90, 3,197 women with invasive breast cancer, identified through the Wisconsin (United States) tumor registry, were interviewed. The method of cancer detection (classified as self, screening mammography, or clinical breast examination [CBE]) was analyzed using polychotomous logistic regression. Fifty-five percent (1,754/3,197) of the women found their own cancers, while 35 percent (1,122/3,197) were detected by screening mammography. Compared with self-detection, the likelihood of non-localized disease was significantly lower for tumors detected by mammography (odds ratio [OR] = 0.3, 95 percent confidence interval [CI] = 0.2-0.4) and CBE (OR = 0.6, CI = 0.4-0.7). The likelihood of cancer being detected by screening mammography increased with increasing age, education, number of prior mammograms, family history, and body mass index (weight/height2) (BMI). Women in the highest BMI quintile were 2.3 times (CI = 1.7-3.0) more likely than women in the lowest BMI quintile to have their cancers diagnosed by mammography. This association most likely results from breast tumors being more difficult to palpate in heavier women.

Adult↗
PubMed1992

Breast cancer detection in relation to oral contraception.

Analyses of tumor size and breast cancer stage were used to determine whether biased detection of breast cancer could have materially influenced estimates of risk associated with use of oral contraceptives. In a population-based case-control study conducted from 1980-1982, surveillance for breast cancer by breast exams, but not mammography, was found to be strongly linked to use of oral contraceptives. Tumors were slightly smaller and less likely to be late-stage (TNM stage III or IV) in patients who had used oral contraceptives. The net effect of any diagnostic bias on advancing the date of cancer diagnosis, whether from breast exams or other sources, was estimated to be less than 8 weeks. This corresponds to spuriously increasing the risk of early-occurring breast cancer in oral contraceptive users by at most 2.4% (relative risk = 1.024).

Adult↗
PubMed2006

Complexed PSA improves prostate cancer detection: results from a multicenter Japanese clinical trial.

OBJECTIVES: To compare the distribution of total and complexed prostate-specific antigen (cPSA) in men with and without prostate cancer with another studied population and to ascertain whether cPSA could enhance the detection of prostate cancer in Japanese men. METHODS: A total of 760 men whose serum total PSA (tPSA) values ranged from 1.0 to 100 ng/mL were enrolled. Serum samples for tPSA and cPSA (ADVIA Centaur) were obtained in all cases. The area under the curve was calculated for comparison of the tPSA and cPSA values. We calculated the number of cancers missed and false-positive results at various cutoff values of cPSA compared with the conventional tPSA threshold of 4.0 ng/mL. RESULTS: Prostate cancer was detected in 268 (35.3%) of 760 patients. cPSA was greater than 8.3 ng/mL (equivalent to 10.0 ng/mL tPSA) in 46.6% of the men with cancer. The area under the curve for cPSA (0.741) was significantly better than that for tPSA (0.721, P <0.001). At a sensitivity of 85% to 95%, significant differences were found in the corresponding specificity between tPSA and cPSA. cPSA at a 3.0-ng/mL threshold detected an identical number of cancers as a tPSA cutoff of 4.0 ng/mL; however, it decreased the false-positive results by 28 cases. CONCLUSIONS: To our knowledge, this is the first report of the distribution of cPSA in Japanese men using a urologic referral population. cPSA can be an alternative to tPSA as the first screening test. A substantial number of men in Japan with prostate cancer are currently diagnosed with a tPSA value greater than 10.0 ng/mL.

Aged↗
PubMed1989

A long-term follow-up study of patients with gastric cancer detected by mass screening.

This report is based on 1,139 patients with gastric cancer (GC) detected by mass screening conducted by the Center for Adult Diseases, Osaka during 1961-1985. Early GC totalled 527 patients and advanced GC totalled 612 patients. In 859 patients curative resection was performed. Their vital status was traced yearly and six patients were lost to follow-up. Relative survival rates of screening-detected GC patients were 69-70% and almost constant after 5 years from operation/diagnosis. The survival curve in which only death from GC was counted as a death was almost equal to the relative survival curve in its shape and value. The hazard rates of screening detected GC patients decreased rapidly within 7 years and remained low after 7 years. It was confirmed by this long-term follow-up study that about two thirds of GC patients detected by screening were successfully cured of their disease.

Adult↗
PubMed1983

Lung cancer detected during a screening program using four-month chest radiographs.

Ninety-two lung cancers were detected in the Mayo Lung Project in patients undergoing chest radiography every four months for screening. Fifty patients had a peripheral nodule, 16 had a perihilar nodule, 20 had hilar or mediastinal enlargement, and six had pneumonitis. The peripheral cancers grew slowly. Ninety per cent were visible in retrospect for months or even years. Despite this, 70% of the peripheral cancers were classified as postsurgical American Joint Committee (AJC) Stage 1. The central cancers grew rapidly, usually presenting as hilar or mediastinal enlargements after normal findings on the previous radiograph obtained four months earlier. Most were classified as AJC Stage 3 tumors.

Adenocarcinoma↗