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Background. This study examined the association between cigarette smoking status and the development of lung metastases in a group of 835 women diagnosed with primary malignant unilateral breast cancer. Method. Female patients with breast cancer diagnosed between 1982 and 1991 at Roswell Park Cancer Institute (RPCI) in Buffalo, New York, who provided information on their cigarette smoking history at the time of their diagnosis were included. The subsequent disease status of patients was monitored by the RPCI Tumor Registry. The Cox regression model was used to estimate the relationship between smoking status and the development of lung metastases, adjusting for the patient's age, stage of disease at diagnosis, and body weight. Results. Of those patients who developed lung metastases, 8.7% were nonsmokers, 14.1% were former smokers, and 14.3% were current smokers. Tests showed that nonsmokers had significantly fewer lung metastases than either of the two smoking groups (P < 0.01). The estimated relative rates of lung metastases developing adjusting for age, stage, and body weight in women who smoked less than 10,000, between 10,001 and 20,000, and more than 20,000 packs over their lifetimes compared with nonsmokers were 1.06 (95% CI, 0.51-2.20), 3.10 (95% CI, 1.5-6. 3), and 3.73 (95% CI, 1.6-8.9) respectively. The Cox regression model showed that every 1000 packs of cigarettes consumed over a lifetime increased a woman's risk of developing lung metastases by about 3% to 7% (P .001). Conclusion. This study found a significant association between cigarette smoking history and risk of lung metastases developing in women diagnosed with primary invasive unilateral breast cancer. The risk of lung metastases developing increased as the number of cigarettes smoked in a lifetime increased. Cancer 1995; 75:2693-9. Key words: cigarette smoking, breast cancer, metastatic lung cancer, lung metastasis from breast.

The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) is a collaborative study of the feasibility and cost-benefit balance of early prostate cancer detection. The ACS-NPCDP uses a comparative, cohort research design with participant eligibility restricted to men 55 to 70 years old who were not already being evaluated for the disease. Two thousand nine hundred ninety-nine men are being followed for five annual examinations using digital rectal examination, transrectal ultrasound, and prostate-specific antigen. All prostate cancer findings are confirmed by pathologic review, At this writing, 9606 annual examination visits have been completed and 194 cancers have been detected. The detection rate for the first-year examination was 2.8%. In the second and third years, the rate decreased to 1.9% and 1.0%, respectively. The characteristics of cancers detected in the ACS-NPCDP indicate that the combined application of digital rectal examination, transrectal ultrasound, and prostate-specific antigen yields detection of clinically significant, potentially curable cancers. Data from the ACS-NPCDP have been used to evaluate the health economics of prostate cancer detection and optimal detection strategies. The available data do not show mortality reduction, and further study of the ACS-NPCDP cohort is required to assess long-term outcomes associated with exposure to prostate cancer early detection. Cancer 1995; 75:1790-4.

Background. In hopes of limiting low-yield prostate biopsies, results of digital rectal examination (DRE), transrectal ultrasound (TRUS), prostate specific antigen (PSA) and age-related PSA values, gland-volume-adjusted PSA levels, and longitudinal PSA changes were analyzed to identify their cost-effectiveness as prognostic indicators in screening, biopsy, and follow-up of patients with prostate cancer. Methods. Twenty-nine hundred men with complete data sets from an initial cohort of 2999 men with an annual follow-up for up to 5 years were examined. Intrapatient PSA and gland-volume variability, optimal PSA operating points (o.p.), and test performance scores were determined for each parameter. Decision analysis was then applied retrospectively to each parameter to determine the cancer detection yield, biopsy requirements, and costs for commonly used detection strategies. Results. For the initial screening decision, the optimal PSA o.p. was 3.0 ng/ml but increased to 5.0 ng/ml in combination with DRE, whereas age-related PSA performed no better than did PSA. The mean intrapatient variability in TRUS gland volume (+5.5 cc) relative to mean volume (34 cc) was 16%, which was less than the 28% (0.64/2.3ng/ml) relative variability for PSA. For biopsy decisions, using PSA density (PSAD) with a level of 0.12 ng/ml/cc there was no significant difference in accuracy compared with the systematic biopsy of all patients with elevated PSA or age-related PSA levels. Rather than perform systematic biopsy on all patients with PSA levels greater than 4 ng/ml, decision analysis showed that a 16-55% reduction in biopsies could be achieved with a respective cancer loss of 4-25% by limiting biopsy to patients with an increased PSAD level and/or abnormal results of DRE. Using age-related PSA criteria in combination with DRE reduced biopsies by achieved but resulted in minimal cost reductions. The greatest biopsy reduction relative to cancer yield and lowest cost per cancer detected occurred with PSAD-driven biopsy strategies. During follow-up, longitudinal changes in absolute PSA and PSAD levels were significantly better (P < 0.05) than the percentage change in PSA levels per year. Conclusions. Cost-effective prostate cancer detection with PSA as a parameter is better achieved if screening and biopsy decisions are not linked intimately. A tailored-biopsy approach for patients with disproportionately elevated PSA levels of suspicious DRE results in the greatest biopsy reduction by selecting lower risk groups for more conservative follow-up.

Background. Previous Commission on Cancer studies on prostate cancer have examined time trends in disease stage, treatment patterns, and survival. The most current National Cancer Data Base data for prostate cancer are reviewed in this report. Methods. Two Calls for Data have yielded a total of 85,813 prostate cancer reports from hospital registries across the country. Results. The proportion of early stage, curable prostate cancers diagnosed in the United States has increased. In 1990, African-American patients were more likely to be diagnosed with metastatic prostate cancer than were non-Hispanic whites. The proportion of patients treated by prostatectomy increased between 1974 and 1990. Consistent with the pattern of more advanced disease at diagnosis, African-American patients were less likely to have received prostatectomy or radiation treatment and more likely to have received only hormonal treatment. Prostate cancer survival was associated strongly with disease stage. African-American men had a lower 5-year survival than did non-Hispanic white men. Conclusions. This information provides national points of reference against which individual hospital performance can be compared and should be particularly helpful to cancer committees, tumor boards, and cancer registrars for the monitoring and evaluation of prostate cancer management in hospital cancer programs. Not all segments of the population-at-risk are benefiting from earlier detection of prostate cancer. Improvements in early detection have important consequences for treatment patterns, allowing the increased use of curative surgical or radiotherapeutic treatment.

Background. Different indexes that may enhance the early detection capability of prostate specific antigen (PSA) have been proposed. In addition to the indexes relating to the normal PSA level, there are data suggesting the usefulness of the PSA level relative to prostate gland volume (PSA density), age-referenced PSA level, and PSA change. Little research comparing the sensitivity and specificity of these measures in the same population has been reported. Methods. All subjects were participants in the American Cancer Society National Prostate Cancer Detection Project. Specificity was studied in 2011 men without prostate cancer, and sensitivity was determined for 171 men with prostate cancer. Results. Prostate specific antigen change showed the highest specificity (96.4%), and PSA density the lowest (85.3%). The most sensitive index was PSA density, which was positive for 74.7% of the 171 cases of known cancer. A PSA change of more than 0.75 ng/ml per year was the least sensitive index (54.8%). Sensitivity and specificity varied in a narrow range. Improved performance in specificity was achieved only with the loss of sensitivity. Conclusions. None of the alternative indexes commonly used in general early detection practice demonstrated particular advantage when compared with the normal PSA concentration, defined as no more than 4.0 ng/ml.

Few data are available to describe the clinical and pathologic characteristics of prostate cancers detected through early detection programs. The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) is a multimodality, multicenter study of the feasibility of early prostate cancer detection using digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). One hundred fifty-six prostate cancers are available from this project for analysis. Methods. The ACS-NPCDP is a prospective, comparative study of a cohort of 2,999 men between 55 and 70 years of age not suspected of having prostate cancer. DRE, TRUS, and PSA are performed for each subject on an annual basis for as long as 5 years. Biopsies are performed on the basis of recommendations from DRE or TRUS results. Although elevated PSA alone was not typically a basis for biopsy, in some instances biopsies were recommended because of the degree of elevation in PSA. Diagnoses are confirmed by participating pathologists and by pathologic analysis. Results. A small proportion of cancers detected were advanced in terms of the clinical stage at time of diagnosis. A total of only six cancers were stage C1 to D1, and five of these were preexisting cancers detected at the first examination. Cancers detected by DRE tended to be more advanced than those found on the basis of only TRUS or PSA. A large proportion of patients received curative therapy, involving radical prostatectomy for 67.9% and radiation therapy for 17.9%. Of 100 men presumed to have organ confined disease and treated by prostatectomy, 64 actually proved to have localized cancer, a rate of upstaging of 36.0%. PSA level and PSA density were associated with the detection of organ confined cancer, but several advanced cancers had PSA levels in the normal range, limiting the usefulness of these measures for staging. Conclusions. The cancers resulting from this multimodality detection effort represented a spectrum of pathologic findings. These data, however, suggest that early detection interventions in men not suspected to have prostate cancer will yield tumors with a favorable stage distribution that are likely to benefit from treatment. Further follow-up evaluation is needed to determine whether these benefits are reflected in long-term mortality and survival experience.

The recent reports from the Canadian National Breast Screening Study (CNBSS) address the effectiveness of breast cancer screening for women in the 40-49 age group and the benefit of adding mammography to standard clinical breast examination in women aged 50-59. Overall, the CNBSS results do not show reductions in breast cancer mortality after seven years of follow-up in either age group. The CNBSS is an important study that includes a large number of women, rigorous procedures, and thorough follow-up, but there are several caveats to interpreting these results. The study results reported to date are based on small numbers of end point events. There are questions about the effectiveness of the randomization procedures in creating cohorts that initially were at equal risk of breast cancer-related death. It also has been observed that the quality level of mammographic screens obtained at the beginning of the study were not as high as those obtained later. Future reports from the CNBSS are planned and may provide additional data helpful in interpreting the results.

Background. Previous research has demonstrated that there is clustering of cancer among relatives of patients with lung cancer and that women may be at a greater risk than men, regardless of their smoking histories. Methods. The authors conducted a study to test the hypotheses that this predisposition varies by the histologic type of tumor and that women with particular histologic types will report more first-degree relatives with cancer than will men with the same cell type. The analyses were based on 872 patients with histologically confirmed lung cancer who had been admitted to Roswell Park Cancer Institute, Buffalo, New York, between 1982 and 1987. Results. More patients with squamous and large cell carcinomas reported two or more relatives with cancer, and overall, women reported more family history of cancer. Among patients with squamous cell carcinoma, this difference between men and women was significant (P < 0.05). Among patients younger than 57 years, those with squamous cell were the most likely to report a family history of cancer (P < 0.01). A similar trend was observed for smoking. Persons with small cell and squamous cell carcinomas who were nonsmokers or had smoked 1-20 years had three times the risk of a family history of cancer than did those with large cell and adenocarcinomas (odds ratio [OR] = 3.01; confidence interval [ci] = 1.38-6.63), in contrast to those who had smoked more than 20 years (OR = 0.85; ci = 0.62-1.62). Conclusions. Squamous cell carcinoma is most associated with familial clustering of cancer, particularly among women, persons younger than 57 years, and individuals who smoked for fewer than 20 years.

Background. The effect of aspirin use on 490 patients with cancer of the colon, 340 with cancer of the rectum as the first primary site, and 212 patients with polyps having no coexisting malignancies was compared with that of two groups of control subjects that consisted of 524 hospital patients having no cancers and no diseases of the digestive organs and 1138 healthy visitors to the screening clinic. All subjects entered Roswell Park Cancer Institute between 1982 and 1991. Methods. After adjustment for adulthood lifetime duration of aspirin use, sex, age, residence, and education, the risk of having cancers and polyps of the colon or the rectum among people who had been using aspirin at least for 1 year before the illness relative to that of nonusers was estimated using multiple logistic regression procedure. Results. The odds ratio estimates showed that the risk of colorectal cancers declined progressively as the frequency of aspirin use increased compared with control groups. Among patients reporting use of aspirin two or more times a day, the odds ratio estimates for colorectal cancers were 0.33 (95% confidence interval [CI], 0.72-0.15) and 0.44 (95% CI, 1.10-0.18) compared with those of screening clinic visitors and hospital control subjects, respectively. The odds ratio for patients with polyps who had used aspirin less than once a day relative to that of nonusers was 0.28 (95% CI, 0.62-0.13) and 0.43 (95% CI, 1.09-0.17) compared with screening clinic visitors and hospital control subjects, respectively. Conclusions. There is a risk reduction effect of aspirin use on the incidence of colorectal cancers and polyps, and this effect is dose related.

Prostate cancer represents an increasing public health burden that may be controlled by early detection interventions. Several studies using transrectal ultrasound (TRUS), prostate-specific antigen (PSA), and digital rectal examination (DRE) in men without known prostate disease have been reported. Recent studies are reviewed, and recent preliminary results of the American Cancer Society-national Prostate Cancer Detection Project (ACS-NPCDP) are presented. Results show that the rate of early prostate cancer detection can be increased by coordinated use of TRUS, PSA, and DRE. The ACS-NPCDP data indicate that the positive predictive value of recommendations to biopsy is improved when based on a combination of studies. Examination by TRUS alone is least specific and least cost-effective, whereas the combination of PSA and DRE is less costly and more specific with equal sensitivity to cancer. Additional data are needed to determine if prostate cancer death rates will be altered by early detection interventions. Physicians and patients need to be informed of the possible risks and benefits of early detection interventions.

Background. The independent effect of race on response to treatment and prognosis in Hodgkin disease is unclear. Methods. The study included 9482 patients with histologically confirmed Hodgkin disease reported by 1084 different hospitals and institutions in the United States. The independent effect of race on response to treatment and recurrence was estimated using the logistic model. Cox proportional hazard model was applied to determine the independent effect of race and other covariables on risk of death. Results. Complete remission occurred in more white patients (67.3%) than black patients (58.2%). Recurrences were reported more often in black patients than in white patients (40.3% and 30.9% respectively). Controlling for confounding variables, race has a significant independent effect on remission and recurrence (P < 0.05). In the first 5 years after diagnosis of Hodgkin disease, the patient age at diagnosis, clinical stage, and histologic type were significant predictors for the risk of death. At 5-10 years after a diagnosis of Hodgkin disease, age, clinical stage, and race of the patient were found to be significant risk factors (whites versus blacks: RR = 0.56; P < 0.05). Conclusions. Race is a significant predictor for remission, recurrence and survival in Hodgkin disease. Black patients have a more unfavorable prognosis than do white patients.

Background. The American Cancer Society-National Prostate Cancer Detection Project is a prospective study of the feasibility of early prostate cancer detection by digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). Two thousand nine hundred ninety-nine men not previously suspected of having prostate cancer have been entered on study in ten participating clinical centers. Methods. The study protocol requires these men to undergo testing with the three detection methods under investigation on an annual basis for up to 5 years. Data currently are available on 1972 men who have completed protocol requirements for two sequential series of examinations. Results. At the first visit, it was recommended that 16.5% of subjects undergo biopsy based on the TRUS and/or DRE findings. Seventy-three (3.7%) men were found to have cancer after the first series of examinations. When the 1899 men who did not have cancer were reexamined, in 11.4%, a biopsy was recommended, and an additional 33 (1.7%) cancers were detected. Cancer detection rates were higher in older men, and the sensitivity of TRUS was higher than that of DRE at both examinations. The positive predictive values (PPV) of TRUS and DRE varied significantly depending on the PSA level; PPV decreased at the second examination. Positive findings during the second examination were associated with elevated PSA levels during the earlier visit and rising PSA levels between examinations. Analyses of the 106 cancers detected currently showed a preponderance of early-stage cancer and low Gleason scores. Conclusions. It may be possible to increase the early detection of prostate cancer by periodic examination by a combination of detection modalities. Cancer 1993; 71:891-8.

Background. Because of the small number of cases five) reported between 1929 and 1969 and a significant increase reported in the decade of the 1970s, the Familial Ovarian Cancer Registry was established in 1981 to study the occurrence of familial ovarian cancer in the United States. Methods. Any woman (with or without ovarian cancer herself) who contacted the Registry and demonstrated a familial history of ovarian cancer was added to the Registry as an index case. Results. From 1981 through May 3l, 1991, 658 families for a total of 1568 cases of familial ovarian cancer were accessioned into the Registry. Of the 219 mothers and 251 daughters with familial ovarian cancer, the mean (58.5 years) and median (57.0 years) age at diagnosis of the mothers was significantly older than the mean (49.8 years) and median (49.0 years) ages of their daughters with ovarian cancer. Significantly more index cases without ovarian cancer had used oral contraceptives as compared to index cases with ovarian cancer (P < 0.001). Significantly more index cases with ovarian cancer used other estrogens as compared to index cases without ovarian cancer (P < 0.001). The Registry cases exhibited a higher proportion of serous adenocarcinoma, poorly differentiated adenocarcinoma, borderline carcinoma, and gonadoblastoma as compared to the 1978 SEER data. Mother and a minimum of one daughter was the most common relationship and was represented in 49.5% of the families with familial ovarian cancer. Sister-sister relationships were the second most frequent and accounted for 38.5% of the 658 families. Conclusions. Familial ovarian cancer occurs most frequently in mother-daughter relationships followed by sister-sister and appears to be an autosomal dominant inheritance with variable penetrance. Cancer 1993; 71:582-8.

Clinical and pathologic data of 36 patients with transitional cell carcinoma of the bladder were investigated to determine the significance on patient survival of these factors: pathologic grade and stage; the immunohistochemistry of eight cell and tumor markers; nuclear DNA flow cytometric parameters; and patient smoking status. The bivariate and multivariate statistical analysis significantly correlated patient survival rates with the immunohistochemical expression of blood group, isoantigens A (P < 0.05), O(H) (P = 0.001), the oncogene-related protein ORP-p21 (P < 0.05), the pathologic grade and stage (P = 0.002), and the tumor DNA ploidy (P < 0.05). Smoking status correlated aneuploidy (P < 0.05) and tumor expression of ORP-p21 (P < 0.05) with the patient survival rate. Despite the relatively small number of patients in this study, the results suggest that the clinicopathologic variables are significant factors in survival of bladder cancer. Cancer 1992; 70:799-807.

The analytic epidemiology of breast cancer has identified several risk factors that may be the bases for developing preventive interventions and refining screening guidelines. Breast cancer risk factors include both personal and environmental sources of risk. The available data, however, do not yet support the feasibility of large scale preventive interventions. Controlled trials will be needed to assess the effectiveness of those approaches. Knowledge of risk factors may be used by physicians to tailor their recommendations for individual patients. Risk factor data also may be used to modify screening recommendations for special populations. A family history of breast cancer may be a basis for modifying screening recommendations but this may be appropriate only for a subset of women with breast cancer in a relative. Cancer 1991; 69:1904-1910.

The American Cancer Society National Prostate Cancer Detection Project is a prospective, multidisciplinary, and multicenter trial to assess the potential for early detection of prostate cancer by transrectal ultrasonography (TRUS), digital rectal examination (DRE), and serum prostate-specific antigen assay (PSA). By November 1990, 2805 men between the ages of 55 and 70 years with no known signs or symptoms of prostate cancer were enrolled in the study, which is planned to run for 5 years. Annual TRUS, DRE, and PSA tests were done on these subjects, and biopsies were recommended for suspicious lesions when detected. To study the performance of PSA testing in presumed normal subjects, all men were eliminated who had (1) prostate cancer detected on their initial examinations and proven by biopsy or (2) cancer detected during the year or subsequent examinations. Additionally, all men with TRUS or DRE findings that were interpreted as suspicious for cancer but who are being followed and have not yet had biopsies done were removed from this series. This left a unique, extensively screened group of 1695 men who were free of prostate cancer, as far as could be determined. Analyses of the PSA levels in this large population in the appropriate age range for increasing risk of prostate cancer revealed several important findings. First, there was a direct relationship between serum PSA levels and estimated prostate volume for both the currently available monoclonal and polyclonal PSA assays. Individuals with benign prostatic hyperplasia and larger gland volume have a higher normal limit of PSA than men with normal gland volume. Second, analyses showed no relationship between age and PSA levels or between symptoms of prostatism and PSA levels independent of gland enlargement. It was concluded that volume-adjusted upper limits of normal PSA can be determined for different levels of specificity desired. This information may be applicable to the use of PSA in men not already suspected of having prostate cancer and may increase its effectiveness as a tool for early detection. Cancer 1992; 69:1201-1207.

The participating institutions of the American Cancer Society National Prostate Cancer Detection Project did 520 biopsies on 2425 men over a 3.5-year period. A total of 88 cancers were confirmed pathologically, 93% of which clinically were organ confined. In 324 men (62.3%), a recommendation for biopsy was made based solely on the results of transrectal ultrasonography (TRUS); in 69 patients (13.3%), solely on the digital rectal examination (DRE); in 116 patients (22.3%), on abnormal DRE and TRUS examinations; and in 11 patients (2.1%), in whom DRE and TRUS were normal, on elevated prostate-specific antigen (PSA) levels. The TRUS was abnormal in 80.6% of men found to have cancer, and the PSA level and DRE were abnormal for 67% and 50% of cancers, respectively. The influence of PSA level on cancer detection increased as the serum level increased above 4 ng/ml. The positive predictive values of both DRE and TRUS were influenced significantly by the presence of an elevated PSA level (P = 0.044 and P < 0.001, respectively). The results of this ongoing multicenter study support the following statements: (1) the prostate cancer detection rate is influenced by this diagnostic triad and (2) the detection rate of organ-confined disease can be improved substantially by early detection programs. Cancer 1992; 69:1195-1200.

Some people seem to regard the elderly as having already lived through most health threats, and may even consider the prevention or early detection of cancer in the elderly to be somewhat misplaced. However, it must be remembered that the average person who reaches the age of 65 may expect to live about 15 additional years. Therefore, there is much to be gained from efforts directed at improving health, even among elders. While quitting smoking may reduce the risk of heart attack and lung cancer, it may also slow down the aging process as well, thereby providing both additional benefit and additional incentive. Older patients should also be warned to be careful about exposure to the sun, which not only increases the risk of skin cancer, but results in increased wrinkling of the skin. Reduction of exposure to sunlight is such a simple preventive measure that there is no reason not to do it. Good nutrition is also important, and older individuals should be advised to follow the guidelines of the American Cancer Society for proper diet. Many older people do not take advantage of cancer screening programs. Ironically, screening programs are most efficient and cost-effective among elders, who experience the highest rates of most cancers. Elderly women should be advised to receive regular mammography for the early detection of breast cancer, and men should be advised about the importance of screening for prostate cancer. Of course, an important aspect of improving both cancer prevention and screening among the elderly is the way in which the programs are developed and delivered to the public. Older Americans are not a homogeneous group. Programs must be made available to minority groups, the physically impaired and impoverished as well as the cognitively impaired and those who reside in nursing homes. The American Cancer Society also warns that older people are particularly susceptible to medical fraud, and efforts must be made to prevent them from falling into programs of cancer prevention, detection, and treatment that have little or no scientific merit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Since 1984, the American Cancer Society (ACS) has provided guidelines for diet and nutrition; it is hoped that these guidelines may help to reduce the risk of cancer. The ACS guidelines are intended for healthy adults, and are not meant to be applied to children, the elderly, pregnant women, people recovering from illness, or other groups, at least without careful consideration. The ACS recommends maintaining a desirable body weight and eating a varied diet. Fruits and vegetables should be included in the diet each day. Total fat intake should be reduced, and more high-fiber foods should be eaten. People who drink alcohol should be moderate in their consumption. Meats and other foods which are cured in salt, smoked, or contain nitrites should be consumed only in limited amounts. The ACS advises that some food additives have, in the past, been found to cause cancer and have been banned. Other food additives, including many preservatives, actually reduce the risk of cancer; such substances must be considered on a case-by-case basis. While there is some indication that vitamin E might help prevent cancer, the evidence is inconclusive at this time. There is also some evidence that the trace metal selenium might protect against cancer, but there is a fine line between therapeutic amounts of selenium and toxic amounts, so people should resist the temptation to take supplements, as a good diet should provide all the selenium necessary. There are conflicting reports concerning coffee. At present, however, there is no reason to believe that moderate amounts of coffee cannot be consumed without increasing risk of cancer. While cholesterol is known to increase the risk of heart disease, there is no conclusive evidence implicating this substance as a risk factor for cancer. Recent laboratory experiments have shown that high-temperature cooking, such as frying, broiling, and grilling, may result in the formation of substances which contribute to cancer risk. The degree to which this might actually affect human health is not yet known, however. (Consumer Summary produced by Reliance Medical Information, Inc.)

In 1980, the American Cancer Society issued guidelines for checkups for the early detection of cancer; at that time, these guidelines produced controversy and debate. The guidelines were not recommendations for mass screening, but rather a guide for the individual patient and physician to determine the best approach to detect cancer in patients without symptoms. These guidelines have had a major impact on the control of cancer in the US. By 1989, 12 major health organizations had adopted policies endorsing the main elements of the guidelines recommended for breast cancer. There have also been documented changes in medical practice and health behavior of Americans since the guidelines were established. In 1984, only 11 percent of American physicians followed the guidelines for mammography (X-ray examination of the breast); however, by 1989 compliance had risen to 37 percent. The percentage of women over 40 who have had mammography increased from 41 percent, in 1983, to 64 percent, in 1987. The increased number of early breast cancers identified is attributed to greater adherence to breast cancer detection procedures. The recommendations made in 1980 were issued as interim guidelines and have since been modified. For example, guidelines for periodic mammography in women between the ages of 40 and 49 were not included in the original guidelines; it is now recommended that these women undergo mammography every one-to-two years. Currently, it is recommended that some women undergo more frequent Pap tests (screening test for cervical cancer). Pelvic examination, including palpation of the ovaries, should be carried out in conjunction with Pap tests; for women over 40, pelvic exam should be performed annually. Elderly Americans may have increased access to cancer detection procedures through changes in Medicare; other Americans may have increased access through insurance coverage for these procedures. Providing early cancer detection for the poor is a much greater challenge; there is a need for much improvement in the availability of preventive health services in the US. (Consumer Summary produced by Reliance Medical Information, Inc.)

Next to lung cancer, prostate cancer is the leading cause of cancer death for men in the United States. About 122,000 men are likely to be diagnosed with prostate cancer this year and 32,000 will die. Unfortunately, many cases of prostate cancer are not diagnosed until the disease has already begun to spread. Since the prognosis of the disease is better if it is caught in the early stages, prostate cancer may be an excellent candidate for improved methods of early detection. The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) was organized to evaluate the practicality and potential success of early detection of this cancer. Currently, the only recommended procedure for screening men who do not have symptoms is the digital (finger) rectal examination. However, ultrasound imaging techniques may prove to be more sensitive in detecting cancer of the prostate. In a continuing study, 2,425 men have so far been examined with both the digital method and transrectal ultrasound (TRUS); none of these men were suspected of having prostate cancer at the time of their initial examination. A total of 396 men, or 16.3 percent of the total, had some abnormality which suggested that a biopsy should be performed; biopsies were performed on 330 of these men. A total of 52 cancers were identified on the basis of biopsy. Overall, this represents a rate of prostate cancer of about two percent among the patients, but the likelihood of prostate cancer varied greatly depending upon age. The rate of prostate cancer was 1.3 percent among men between the ages of 55 and 60, while the rate among the patients over 65 was 3.3 percent. The rectal ultrasound method proved to be more sensitive than the digital exam; 44 patients, or 84.6 percent of the cancer cases, were detected by ultrasound, in contrast with 33 cases (63.5 percent) which were detected by digital examination. It remains to be determined how effective these procedures might be when used in a larger-scale mass screening program, but the preliminary results seem encouraging. (Consumer Summary produced by Reliance Medical Information, Inc.)

Older patients with Hodgkin's disease suffer a significantly poorer prognosis than do younger patients. However, the cause for this is not clear. Determining the true nature of the relationship between age and prognosis requires that confounding factors be properly controlled for. For example, older patients may be more conservatively staged, which would increase their risk. Younger patients might be treated more aggressively and watched more closely, optimizing their chances. In an effort to evaluate the effect of age on the prognosis of Hodgkin's disease, data on 6,345 patients collected by the Patterns of Case Study sponsored by the American College of Surgery were used. These data provide information on 19 clinical and 11 pathological tests, as well as clinical stage and pathologic stage. This permitted the comparison between older and younger patients who were graded and treated equivalently. Although the matching reduced the apparent size of the age effect, there remained nonetheless a significantly poorer prognosis for older people with Hodgkin's disease than younger. While factors such as disease stage correlate with age, age is an independent predictor of poorer prognosis in Hodgkin's disease patients. (Consumer Summary produced by Reliance Medical Information, Inc.)