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PubMed1998

Is there an increased risk of second primaries following prostate irradiation?

PURPOSE: To assess the risk of developing a second primary cancer following prostate irradiation compared to the underlying risk in patients with prostate cancer. METHODS AND MATERIALS: The baseline rate of secondary cancers following prostate cancer was obtained from a study of 18,135 patients from the Connecticut Tumor Registry, of whom only 12.5% received radiotherapy. These patients, with a mean age of 72 and a mean follow-up of 3.9 years, were compared to a cohort of 543 patients (median age 70) with similar follow-up (median 3.9 years), all of whom were treated with definitive radiotherapy at Fox Chase Cancer Center. The possible association between various covariates (age, dose, palpation stage, field size, Gleason score, pretreatment PSA) and the development of a secondary cancer was assessed. RESULTS: 1,053 of 18,135 patients (5.8%) in the Connecticut Tumor Registry developed a second primary cancer compared with 31 of 543 (5.7%) patients treated with prostate radiation (p = 0.99). Although this risk increases gradually over time, it is not significantly different, at any time period, between the two groups of patients. Of the 31 secondary primaries in the irradiated group, 82% had a history of tobacco and/or alcohol use. Only melanomas were significantly increased compared to the expected rate in an age-matched population (p < 0.001). Five of the 31 secondary cancers occurred within the radiation field (four bladder, one colon), four within 3 years and only one occurred 9 years after radiotherapy. No association was found between age (<70 vs. > or =70 and as a continuous variable), dose (<74 vs. > or =74 Gy), palpation stage ( or =T2C), field size (prostate vs. pelvic), radiation technique (conventional vs. conformal), Gleason score (2-6 vs. 7-10), or pretreatment PSA (<15 vs. > or =15 and as a continuous variable) and the risk of developing a second primary. Although a lower radiation dose (as a continuous variable) correlated with an increased risk of developing a secondary cancer (p = 0.04), this phenomenon is likely due to differences in follow-up time. CONCLUSION: Up to at least 10 years, there is no increased risk of developing a second primary cancer following prostate irradiation compared to the baseline rate from prostate cancer itself. This risk is not higher in younger patients with localized disease (<T2C), who often must choose between surgery and radiation. The vast majority of secondary cancers occurred outside of the radiation field (84%) and/or within 3 years of radiotherapy (97%), suggesting they were not caused by radiation. Most of these patients had lifestyles with predisposing risk factors. Patients with prostate cancer manifested a significantly increased risk of developing melanomas, suggesting that they may benefit from patient education and skin screening examinations.

Aged↗
PubMed2003

Geographic variation within the United States in the incidence of hepatocellular carcinoma.

Geographic variation in hepatocellular carcinoma (HCC) has not been previously studied in the United States. Using data collected by the Surveillance, Epidemiology, and End Results registries (SEER) and the 1990 Behavioral Risk Factor Surveillance System (BRFSS), we analyzed incidence and risk factors for HCC in nine geographic regions in the United States. We identified all individuals with HCC during 1975-1998 in five states (Connecticut, Iowa, Utah, New Mexico, and Hawaii) and four metropolitan areas (Detroit-Metropolitan, San Francisco-Oakland, Seattle-Puget Sound, and Atlanta-Metropolitan). Age-adjusted incidence rates were calculated for each geographic region. The association between HCC incidence and geographic regions were examined in Poisson multivariate regression model controlling for age, gender, race, and year of diagnosis. Hierarchical linear modeling was also used to examine these associations while adjusting for potential clustering of persons with similar characteristics within geographic regions, and to assess the effect of the prevalence of smoking, alcohol use, obesity, and diabetes in the underlying population in these geographical regions. A total of 11,547 persons with HCC were examined. Hawaii had the highest age-adjusted incidence rate (4.6), followed by San Francisco-Oakland (3.2), New Mexico (2.0), Detroit-Metropolitan (1.9), Seattle-Puget Sound (1.8), Atlanta-Metropolitan (1.7), Connecticut (1.6), Iowa (1.1), and Utah (1.0); all rates per 100,000. Whites had an age-adjusted incidence rate of 1.5, Blacks 3.2, and other races "Asian, American Indian, Pacific Islander" 7.0. However, Blacks and "other races" in Seattle-Puget Sound had higher age-adjusted incidence rates (4.4 and 8.2, respectively) than Blacks and other races in any other registry, while Whites in Hawaii had a higher rate (2.5) than Whites in any other registry. In general, men had a two to three times higher age-adjusted incidence rate than women. However, Hawaiian men had significantly higher age-adjusted rates (7.0) than men in other regions, while Utah had the lowest rates of HCC in men (1.5). Adjusting for variations in ethnicity, gender, age, and time of diagnosis, the Poisson regression analysis showed persistent geographic differences in HCC as well as a change in the order with New Mexico having the highest HCC incidence followed San Francisco-Oakland. Hierarchical linear modeling confirmed geographic variations in HCC but failed to show a significant effect for the prevalence of smoking, alcohol use, obesity, and diabetes in the underlying population. Significant geographic variation in HCC incidence exist in the United States. These variations are only partly explained by differences in age, gender, race, and year of diagnosis.

Age Distribution↗
PubMed2001

Laparoscopic cholecystectomy does not demonstrably decrease survival of patients with serendipitously treated gallbladder cancer.

BACKGROUND: The purpose of this study was to evaluate the possibility that laparoscopic cholecystectomy has worsened the prognosis of patients with resected gallbladder cancer; particularly for patients whose cancer was accidentally resected. STUDY DESIGN: We conducted a retrospective review of Connecticut Tumor Registry data and data extracted from individual patient records at 15 of 30 hospitals in Connecticut reporting data to the Registry, at two separate time points, 1985-1988 (immediate prelaparoscopic era) and 1992-95 (laparoscopic cholecystectomy well established). There were 194 and 208 patients in each 3-year period, respectively. Additional information was extracted from hospital records in 82 and 91 patients, respectively. Twenty-five percent of patients in both data sets presented with "local" or Tis, T1, T2 disease. RESULTS: Three-year survival for localized disease was 29% in the prelaparoscopic period and 34% once laparoscopic cholecystectomy was established. But analysis of individual patient records indicated that 36% of patients from the laparoscopic period did not actually undergo a laparoscopic procedure. Fifty-nine patients had their gallbladder cancer discovered in the specimen postoperatively (serendipitously treated). A higher proportion of cancers were discovered postoperatively in the laparoscopic era (44% versus 24%). Three-year survival for these patients was 25%. If the data from the two eras are grouped according to whether or not the cancer-bearing gallbladder was manipulated laparoscopically, 24 of 59 patients (41%) turned out to be at risk for the possibility of increased laparoscopic dissemination of tumor. Survival of these patients (11-month median survival) was not statistically different from survival of patients whose serendipitously discovered gallbladder cancer was never manipulated laparoscopically (16-month median survival); p = 0.54 by log rank test. CONCLUSIONS: The widespread adoption of laparoscopic cholecystectomy did not worsen the survival of patients with gallbladder cancer, and patients with serendipitously treated gallbladder cancers did not have a worse survival after laparoscopic manipulation than after a standard open cholecystectomy. The laparoscopic aspects of operative manipulation of a gallbladder with cancer in it do not appear to be a proximate cause of the poor prognosis in this disease.

Aged↗
PubMed2002

Physician attitudes concerning anticoagulation services in the long-term care setting.

OBJECTIVES: There is little experience in the use of specialized anticoagulation services in the long-term care setting. Even less is known about physician attitudes regarding these services. To examine this issue, we surveyed physicians caring for nursing home residents in a sample of long-term care facilities located in Connecticut. METHODS: We surveyed physicians providing care to nursing home residents of a convenience sample of 21 Connecticut nursing homes. (These facilities had participated in a quality assessment and improvement project on preventing strokes in nursing home residents with atrial fibrillation.) Physicians were requested to complete a structured questionnaire about the challenges to managing nursing home residents on warfarin therapy and preferences concerning the use of an anticoagulation service to manage warfarin therapy in this setting. RESULTS: A total of 245 physicians were asked to participate in the survey, and 114 (47%) responded between November 5, 1999 and January 14, 2000. Of the 114 physicians who returned the survey, 91 reported that they currently cared for residents in long-term care facilities and thus completed the questionnaire. The majority of respondents agreed or strongly agreed that an anticoagulation service would reduce the workload on physicians, increase the costs of care for nursing home residents on warfarin, and increase the percent of time that nursing home residents on warfarin are maintained in the target therapeutic range. Most physicians disagreed or strongly disagreed with statements suggesting an anticoagulation service would decrease the costs of care for nursing home residents on warfarin, reduce the liability of the prescribing physician, interfere with their ability to care for patients on warfarin therapy, and reduce the risk of warfarin-related bleeding. Forty-five percent of respondents agreed with a statement that an anticoagulation service would intrude on physician decision-making. Only about half (53%) of the respondents indicated that they would or might utilize an anticoagulation service for managing their long-term care patients on warfarin. CONCLUSIONS: Use of a specialized anticoagulation service to manage warfarin therapy is a systems-level approach with the potential to improve the effectiveness and safety of this treatment. Physician skepticism regarding the usefulness of anticoagulation services will only be overcome by subjecting this approach to rigorous evaluation and by assuring physicians of their ongoing involvement in decision-making regarding warfarin therapy in their patients.

Anticoagulants↗
PubMed2003

Family history of breast and ovarian cancer and the risk of breast carcinoma in situ.

UNLABELLED: A family history of breast cancer is an important risk factor for breast carcinoma in situ (BCIS), however, there are no detailed analyses of its variation in effect by number, type, laterality or age at onset of affected relatives nor by association with ovarian cancer. In addition, the role of the breast cancer susceptibility genes, BRCA1 and BRCA2, in the development of BCIS is unclear. OBJECTIVE: To better define the role of: (1) a family history of breast and ovarian cancer and (2) the cancer susceptibility genes, BRCA1 and BRCA2, in the development of BCIS. METHODS: The data are 875 ductal carcinoma in situ (DCIS) and 123 lobular carcinoma in situ (LCIS) cases diagnosed among residents of the state of Connecticut from September 15, 1994 to March 14, 1998 and between the age of 20 and 79 years. Controls (n = 999) are female Connecticut residents collected via random-digit-dial and frequency matched to the cases by 5-year age intervals. Telephone interviews were used to collect information on risk factors and cancer screening history. Logistic regression was used to provide maximum likelihood estimates of the odds ratios (OR) with 95% confidence intervals (95% CI). The probability of being a BRCA1 and/or BRCA2 gene carrier was calculated for each case and control, using family history of breast and ovarian cancer, age/age at diagnosis for relatives, prevalence and penetrance data for BRCA1/BRCA2, and self-report of Jewish heritage. RESULTS: Cases with DCIS or LCIS were significantly more likely to report a first degree family history of breast cancer (OR: 1.6, 95% CI: 1.3, 2.1 and 1.8, 95% CI: 1.2, 2.9, respectively) than were controls. In addition, DCIS cases were 2.4 (95% Cl: 0.8, 7.2) times more likely than controls to report both an affected mother and sister. An inverse association was suggested between age at onset and DCIS risk with cases aged 49 years or younger at 2.1 (95% CI: 1.3, 3.4) times the risk of controls (95% CI) versus 1.5 (95% CI: 1.1, 2.0) for cases older than 49 years. An elevated risk of DCIS was associated with a family history of ovarian cancer but did not reach statistical significance (OR: 1.3, 95% CI: 0.7, 2.5). Approximately 3.7% and 1.9% of DCIS cases were predicted to carry a mutation in BRCA1 and BRCA2, respectively. CONCLUSIONS: A family history of breast cancer is associated with an increased risk of DCIS and LCIS, particularly among women with multiple relatives affected at early ages. Statistical risk models predict a low prevalence rate of BRCA1 and BRCA2 in DCIS; these estimates await confirmation through laboratory testing.

Breast Neoplasms↗
PubMed2003

Tiagabine increases cocaine-free urines in cocaine-dependent methadone-treated patients: results of a randomized pilot study.

AIMS: We sought to evaluate the safety and efficacy of the GABAergic agent tiagabine in reducing cocaine use among methadone-treated patients. DESIGN: Ten-week randomized double-blind placebo-controlled trial. SETTING: Opiate Treatment Research Program, Veteran's Affairs Connecticut Healthcare System in West Haven, Connecticut, USA. PARTICIPANTS: The participants were 45 cocaine-dependent methadone-treated patients who were predominately Caucasian (75.6%), male (77.8%) and never married (53%) with an average age of 38 years (SD = 6.5). INTERVENTIONS: Comparison groups received tiagabine 12 mg/day (n = 15), tiagabine 24 mg/day (n = 15) or placebo (n = 15). MEASURES: Baseline assessments included the Structured Clinical Interview for DSM-IV, the Addiction Severity Index, a urine drug test, self-reported use and opiate withdrawal scales. Urine drug tests were performed thrice weekly. FINDINGS: Treatment retention was over 80% for all treatment groups. The sample mean (+/- SE) of cocaine-free urines for the first week after study entry and before tiagabine was started was 1.16 (0.19) urines/week. During weeks 9 and 10 cocaine-free urines increased significantly from baseline by 33% with high-dose tiagabine (24 mg/day), by 14% with low-dose tiagabine (12 mg/day) and decreased by 10% with placebo (hierarchical linear model, Z= 2.03; P < 0.05). Self-reported cocaine use also decreased significantly more with active medications than with placebo. CONCLUSIONS: Tiagabine at 24 mg/day was well tolerated among these methadone-treated patients with only one reporting headache. Tiagabine appears to be a promising GABAergic medication that moderately improves cocaine-free urines.

Adult↗
PubMed2002

Cannabis use: consistency and validity of self-report, on-site urine testing and laboratory testing.

AIMS: To evaluate the agreement between adolescent self-reported cannabis use, "on-site" qualitative urine screening, and quantitative laboratory testing. DESIGN: A cross-sectional study of intake and follow-up data from 248 adolescents entering substance abuse treatment for cannabis use disorders (abuse or dependence). This is part of the multi-site cooperative agreement Cannabis Youth Treatment study. SETTING: Data collected from adolescents randomly assigned to one of five outpatient treatments at four sites: Operation PAR, Inc., Florida; Chestnut Health Systems, Illinois; University of Connecticut Health Center, Connecticut; and Children's Hospital of Philadelphia, Pennsylvania. PARTICIPANTS: The data represent 248 unique individuals from a sample of 297 adolescents ranging in age from 12 to 18 years. MEASUREMENTS: Prevalence, agreement, kappa, sensitivity, specificity, positive and negative predictive value. FINDINGS: The self-report rates were higher at intake than either urine test (82.4% vs. 77.0% vs. 52.7%), but both lower and higher at the 3-month follow-up (55.5% vs. 70.0% vs. 47.3%) and 6-month follow-up (60.2% vs. 73.5% vs. 55.8%). The disagreements went in both directions and the kappa coefficients were only in the moderate range (0.4). Over two-thirds of these frequent cannabis users tested positive when they said they had not used in 1 week and one-third tested positive even though they said it had been more than 4 weeks since last use. CONCLUSIONS: The findings suggest both the advantages of multiple sources of information and the need for further work on the latency of cannabis metabolites in clinical populations.

Adolescent↗
PubMed2001

Do Wolbachia infections play a role in unidirectional incompatibilities in a field cricket hybrid zone?

Two closely related field crickets, Gryllus firmus and G. pennsylvanicus, hybridize along an extensive north-south zone in the eastern United States. Crosses between G. firmus males and G. pennsylvanicus females produce viable and fertile F1, but the reciprocal cross consistently fails to produce offspring. Wolbachia, a bacterial parasite of arthropods that causes unidirectional incompatibilities in a variety of insect species, has been suggested as the cause of the observed incompatibility between G. pennsylvanicus and G. firmus. We examine the presence/absence of Wolbachia strains, defined by sequencing the ftsZ gene, in four cricket populations from the north-eastern United States. Most G. firmus individuals are infected (100% in Guilford, Connecticut; 65% in Seaside Park, New Jersey) and > 95% of those infected harbour a single strain of Wolbachia. All individuals in G. pennsylvanicus populations (Ithaca, New York; Sharon, Connecticut) are infected; the majority of individuals carry a second strain of Wolbachia, but a significant fraction carry the same strain found commonly in G. firmus. The presence of an apparently identical Wolbachia strain in crickets of both species means that some crosses between G. pennsylvanicus males and G. firmus females should be compatible. We have no evidence of such compatibility. Furthermore, if Wolbachia infections are responsible for the observed incompatibility between species, then incompatibilities must also exist within G. pennsylvanicus, because this species harbours both Wolbachia strains. Although some single pair crosses within G. pennsylvanicus do fail to produce offspring, the proportion is lower than expected if Wolbachia were responsible. Therefore, Wolbachia is unlikely to be involved in reproductive isolation between the two cricket species.

Animals↗
PubMed1992

Evidence that dyslexia may represent the lower tail of a normal distribution of reading ability.

BACKGROUND: Dyslexia is now widely believed to be a biologically based disorder that is distinct from other, less specific reading problems. According to this view, reading ability is considered to follow a bimodal distribution, with dyslexia as the lower mode. We hypothesized that, instead, reading ability follows a normal distribution, with dyslexia at the lower end of the continuum. METHODS AND RESULTS: We used data from the Connecticut Longitudinal Study, a sample survey of 414 Connecticut children who entered kindergarten in 1983 and were followed as a longitudinal cohort. Dyslexia was defined in terms of a discrepancy score, which represents the difference between actual reading achievement and achievement predicted on the basis of measures of intelligence. Data were available from intelligence tests administered in grades 1, 3, and 5 and achievement tests administered yearly in grades 1 through 6. For each child there were 108 possible discrepancy scores ([3 x 3 years] x [2 x 6 years]) based on combinations of the ability scores (full-scale, verbal, and performance IQ) in each of three years and two achievement scores (reading and mathematics) in each of six years. We demonstrated that each of the discrepancy scores followed a univariate normal distribution and that the interrelation of two different discrepancy scores followed a bivariate normal distribution. At most, only 9 of 108 discrepancy scores (8.3 percent) and 171 of 3402 pairs of discrepancy scores (5.0 percent) were significantly different (at the 5 percent level) from the expected scores--well within the expected values for data with univariate and bivariate normal distributions, respectively. We also examined the stability of dyslexia over time. The normal-distribution model predicted (and the data indicated) that only 7 of the 25 children (28 percent) classified as having dyslexia in grade 1 would also be classified as having dyslexia in grade 3. CONCLUSIONS: Reading difficulties, including dyslexia, occur as part of a continuum that also includes normal reading ability. Dyslexia is not an all-or-none phenomenon, but like hypertension, occurs in degrees. The variability inherent in the diagnosis of dyslexia can be both quantified and predicted with use of the normal-distribution model.

Child↗
PubMed1950

Immunological reactions of the Coxsackie viruses. I. The neutralization test; technic and application.

The neutralization test is a reliable and useful procedure for following immunological reactions of the Coxsackie viruses (C virus). The standard procedure has been an incubation period of 1 hour at room temperature followed by subcutaneous inoculation into newborn mice. However, this time and temperature are not critical, for the virus in neutralized within 10 minutes of mixing with immune serum and remains neutralized for long periods. During the variable incubation periods used, the control virus remained active, even in dilute suspensions. The neutralization test is not affected by the presence or absence of complement. Neutralizing antibody is stable at 65 degrees C. for 30 minutes, and immune serum has to be heated to 80 degrees C. for 30 minutes before the antibody is no longer detectable. As the quantity of virus is increased, the quantity of serum required for neutralization likewise increases, but not in a regular or predictable fashion. Neutralized mixtures of the virus can be made infective again by simple dilution before inoculation. The neutralization test is a satisfactory means for typing Coxsackie viruses. At least seven antigenic types have been identified. Similar antigenic types have been found to be scattered over wide areas. Thus the Conn.-5 type was present in 1948 in Massachusetts, Connecticut, New York, and North Carolina. The Texas-1 type was present in 1943 in Connecticut and in 1948 in North Carolina and Texas. Further information on the specificity of the neutralizing antibody response has been obtained from a study of the occurrence and development of antibodies in 6 patients who contracted infections with one or another of the C viruses while working with them in the laboratory. From each patient a virus was isolated during the illness. No patient had detectable antibodies to his strain before his illness, but each soon thereafter developed antibodies to his own strain and to the prototype strain to which it was related. By means of the neutralization test, it has been shown that a family epidemic may include two different immunological types of virus. Neutralizing antibodies appear at the time of or soon after onset of illness, increase rapidly to titers of about 1:1000 which are maintained during the period of 1 to 3 months following infection, and are still present 2 years later, although at lower levels. Neutralizing antibodies are present in the normal population. In North Carolina, over 80 per cent of the children have antibodies at birth. The level falls rapidly to a minimum of 14 per cent at the age of 1, and then it quickly rises to reach the adult level at the age of 7. Gamma globulin collected in various parts of the United States between 1944 and 1949 and in Denmark in 1949 neutralizes at least four antigenically different Coxsackie viruses.

Adult↗
PubMed2004

Dramatic decrease in the incidence of Salmonella serotype Enteritidis infections in 5 FoodNet sites: 1996-1999.

Salmonella serotype Enteritidis (SE) emerged as the most common Salmonella serotype among infected persons in the United States during the 1980s and 1990s, with infections reaching a peak in 1995. During the past decade, farm-to-table control measures have been instituted in the United States, particularly in regions with the highest incidence of SE infection. We report trends in the incidence of SE in the 5 original surveillance areas of the Foodborne Diseases Active Surveillance Network during 1996-1999: Minnesota, Oregon, and selected counties in California, Connecticut, and Georgia. Overall, the incidence of SE decreased 46% from 1996 to 1999. The greatest decrease was in Connecticut (71%), followed by northern California (50%), Minnesota (46%), and Oregon (13%). Although SE infection remains an important public health concern, there has been a remarkable decrease in its incidence. This decrease may be a result of targeted interventions, including on-farm control measures, refrigeration, and education efforts.

Female↗
PubMed1976

Hodgkin's disease in American Negroes. Histologic classification of the disease in 143 untreated patients, and age distribution.

The Rye histologic classification of Hodgkin's disease has been applied to 143 previously untreated cases of Hodgkin's disease in Negro patients seen in four hospitals in Washington, D.C.,during a 16-year period (1959-1974). The frequencies and age distributions of histologic subtypes were compared with those in American and two African series. Those histologic subtypes associated with poor prognoses (mixed-cellularity and lymphocytic depletion) predominated in American Negroes and in Negroes from Ibadan, Nigeria, and Kampala, Uganda. In an American series from Connecticut (approximately 98% Caucasian) the histologic subtypes lymphocytic predominance and nodular sclerosis were preponderant. There were statistically significantly less of the nodular sclerosis subtype (P less than 0.005), and more of the mixed-cellularity subtype in American Negroes compared with the Connecticut series (P less than 0.001). In contrast to findings in predominantly Caucasian populations, there was a predilection of the nodular sclerosis subtype for males in American and in African Negroes. This study showed that Hodgkin's disease in American Negroes epidemiologically corresponds to the so-called "intermediate pattern" of the disease.

Adolescent↗
PubMed2003

Impact of four urban perinatal hepatitis B prevention programs on screening and vaccination of infants and household members.

During 1992-2000, the authors studied compliance with perinatal hepatitis B prevention recommendations, including vaccination of household contacts, at four metropolitan sites in Connecticut, Georgia, Texas, and Michigan. Demographic and hepatitis B-related knowledge, attitudes, practices, and barrier data were collected on pregnant women testing positive for hepatitis B surface antigen and on their infants, children, and household and sexual contacts. Generalized estimating equations with repeated measures in a multivariable model were used to obtain adjusted relative risks of household noncompliance. In 1,458 households studied, 1,490 infants and 3,502 other contacts were identified. Among infants, vaccination start/finish rates were 92%/72%, and 73% were serotested postvaccination. Prevaccination serotesting rates among contacts were 22% preenrollment and 47% postenrollment. Among 2,519 contacts whose immunity status was susceptible or unknown, the vaccination start/finish rate was 45%/41%. Site-specific adjusted relative risks of household noncompliance compared with Texas were 2.14 (Michigan), 1.96 (Georgia), and 1.30 (Connecticut). Mother's birth in the United States increased the relative risk of household noncompliance (1.32). Home visits, implemented only in Texas, most likely account for higher compliance rates in that state. Findings may indicate that many perinatal programs could achieve higher overall rates of infant and contact identification; pre- and postvaccination serologic testing in contacts and infants, respectively; and contact hepatitis B vaccination.

Adult↗
PubMed1982

Temporal trends in breast cancer.

Time-depth breast cancer mortality data from the United States, England and Wales, Canada, and Japan, and breast cancer incidence data from Connecticut, Denmark, and Osaka, Japan, were analyzed. The temporal trends in mortality have been similar in the populations examined. Risks for individual cohorts decreased until about the cohort of 1900, when they began to increase. This pattern can account for the observed increases in the rates at perimenopausal ages (40-55 years). Although the magnitudes of mortality rates in Japan are about one fifth those in the West, they have been changing over time in much the same way as in the West. Cohort effects in incidence in Connecticut and Denmark also dipped around 1900. In Osaka, cohort effects rose from the cohort of 1901 to the cohort of 1936.

Adult↗
PubMed1984

Assessing the validity of observed cancer incidence trends.

The available cancer incidence data from the National Cancer Institute surveys, the Surveillance, Epidemiology, and End Results (SEER) Program, and the Connecticut Tumor Registry are examined for the period from the late 1940s to the present. Two indicators of completeness and accuracy of reporting (percentage of cases reported only by death certificate and percentage of cases with histologic confirmation of the diagnosis) show considerable variation, particularly in the past, but no consistent strong patterns indicating noncomparability of the data are apparent. Incidence data for five geographic areas (Atlanta, Detroit, San Francisco-Oakland, Iowa, and Connecticut) are examined for several primary sites by area and age, and are compared with mortality data for the same areas and the entire country. A variety of patterns in the trends are apparent. For several sites, the incidence trends are similar to what would be predicted based on the mortality patterns, but differences are apparent for other sites. Mortality trends may be influenced by shifts in diagnostic specificity on the death certificates and by changes in survival rates, and both incidence and mortality rates may be influenced by increased casefinding, improvements in diagnostic procedures, expansion of the medical care delivery system, and real changes in the prevalence of risk factors. Therefore, both incidence and mortality data should be used when attempting to assess the real trends in cancer occurrence because sole reliance on one or the other may lead to erroneous conclusions.

Adult↗
PubMed1994

Changing patterns of anal cancer incidence in the United States, 1940-1989.

Anal cancer has been hypothesized to be associated with a sexually transmitted agent and, more recently, with the epidemic of human immunodeficiency virus (HIV). The authors used a descriptive incidence study to evaluate these hypotheses based on US data from the Surveillance, Epidemiology, and End Results (SEER) program for 1973-1989 and from the Connecticut Tumor Registry for 1940-1988. Since 1960, anal cancer incidence in Connecticut increased 1.9-fold among men and 2.3-fold among women. Based on information from SEER, the incidence was lowest among white men (1973-1989 average: 0.41/100,000) and highest among black women (1973-1989 average: 0.74/100,000). Residents of the metropolitan areas had a twofold risk of anal cancer compared with populations in less densely populated areas. The most dramatic change in incidence was observed for white men in the San Francisco Bay area, among whom the incidence increased from 0.5/100,000 in 1973-1975 to 1.2/100,000 in 1988-1989 (p trend < 0.001). The relative risks (95% confidence intervals) of anal cancer among never married men compared with ever married men in the urban areas rose from 5.8 (0.9-8.7) in 1973-1978 to 6.7 (4.7-9.5) in 1979-1984 and 10.3 (7.5-14.1) in 1985-1989 (p trend = 0.02). No significant difference was observed among women. In conclusion, anal cancer incidence in the United States has increased significantly during the past 30 years and is now higher in women than men, in blacks than whites, and in residents of metropolitan rather than rural areas. Some of this changing pattern clearly relates to the period prior to the acquired immunodeficiency syndrome (AIDS) epidemic and argues that behavioral changes are important in anal cancer development. However, the recent remarkable change in rates among never married men and men living in the San Francisco Bay area suggests that homosexual men are at special and increasing risk. The authors speculate whether part of this recent increase could be attributed to the AIDS epidemic.

Adult↗
PubMed1998

Injection and syringe sharing among HIV-infected injection drug users: implications for prevention of HIV transmission. Supplement to HIV/AIDS Surveillance Group.

Because HIV-infected injection drug users (IDUs) can transmit HIV infection, we investigated factors associated with sharing of syringes in the past year among IDUs infected with HIV. We analyzed data from an interview survey of 11,757 persons > or = 18 years of age with HIV or AIDS between June 1990 and August 1995 who were reported to 12 state or city health departments in the United States. Of the 1527 persons who had ever shared syringes and reported injecting in the 5 years before the interview, 786 (51%) had injected in the year before interview, and of these, 391 (50%) had shared during that year. IDUs who were aware of their HIV infection for >1 year were less likely to share (43%) than those who were aware of their infection for 1 year or less (65%, adjusted odds ratio=2.15, 95% confidence interval, 1.52-3.03). The only statistically significant time trend was that the proportion of IDUs from Connecticut who shared decreased from 71% in 1992 to 29% in 1995. This trend appears to be related to the 1992 changes in Connecticut laws that allowed purchase and possession of syringes without a prescription. Because many HIV-infected IDUs continue to inject and share, prevention efforts should be aimed at HIV-infected IDUs to prevent transmission of HIV. Early HIV diagnosis and access to sterile syringes may be important methods for reducing syringe sharing by HIV-infected IDUs.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Merkel cell carcinoma: five case reports using sentinel lymph node biopsy and a review of 110 new cases.

Merkel cell carcinoma is an uncommon cutaneous tumor that is considered locally aggressive and often spreads regionally through lymphatic channels. Evaluation of surgical treatment methods has been hampered by the low incidence of this tumor. Current standards of treatment include wide surgical excision and regional lymphadenectomy if clinically suspicious nodes are present. However, the development and increasing use of sentinel node imaging and biopsy have expanded the diagnostic options. This article presents information on 110 Merkel cell carcinomas treated in Connecticut between 1990 and 1997. Statistics on gender, age, disease location, treatment, and mortality are reviewed. Using the census data for Connecticut, the annual incidence for this disease was calculated to be 0.42 cases per 100,000 people. A series of five cases treated with wide excision and sentinel lymph node biopsy is also presented.

Adult↗