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Abramson Cancer CenterNCI CANCERLIT® Search: Screening and Prevention of Digestive Cancers - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
UI - 11916350
AU - Calza S; Ferraroni M; La Vecchia C; Franceschi S; Decarli A
TI -
Low-risk diet for colorectal cancer in Italy.
SO - Eur J Cancer Prev 2001 Dec;10(6):515-21
AD - Istituto di Statistica Medica e Biometria, Universita degli Studi di
Milan, Italy. stefano.calza@unimi.it
An innovative approach was used to define a low-risk diet for colorectal
cancer from a multicentric case-control study of 1953 incident cases and
4154 hospital controls from Italy. A logistic regression model was
fitted on the reported intake of five macronutrients, and the estimated
coefficients were used to compute a diet-related logistic risk score
(LRS). The mean of LRS within risk decile ranged from 0.89 to 1.86.
Total energy intake and absolute consumption of each macronutrient
increased with increasing LRS. In relative terms, however, starch intake
showed an almost threefold increase across subsequent score levels,
while a decline was observed for unsaturated fat, sugar and protein.
Saturated fat consumption remained fairly stable in relative terms. When
food groups were considered, bread and cereals dishes, cakes and
desserts and refined sugar were positively associated, while the
consumption of vegetables, fruit, fish, poultry and olive oils was
inversely associated with LRS.
2
UI - 11588895
AU - Oh YJ; Sung MK
TI -
Soybean saponins inhibit cell proliferation by suppressing PKC
activation and induce differentiation of HT-29 human colon
adenocarcinoma cells.
SO - Nutr Cancer 2001;39(1):132-8
AD - Department of Food and Nutrition, Sookmyung Women's University, Seoul,
140-742, Korea.
Soybeans are major dietary sources of saponins, which have been
suggested as possible anticarcinogens. This study was performed to
determine the effect of soybean saponins on cell proliferation,
differentiation, and apoptosis in human colon cancer cells. HT-29 cells
were incubated in various concentrations of saponins for 24, 48, and 72
hours. Cell growth and whole cell protein kinase C (PKC) activity were
determined. Alkaline phosphatase activity and carcinoembryonic antigen
level were measured as markers for cell differentiation. Apoptotic cells
were quantified. Study results indicated that soybean saponin treatment
decreased cell growth in a concentration-dependent manner, and
pre-treatment of the cells with saponins significantly suppressed the
12-O-tetradecanoyl phorbol 13-acetate-stimulated PKC activity. Cells
treated with 300 and 600 ppm of saponins significantly increased
alkaline phosphatase activity by 146% and 242% of the control,
respectively. Also, 4-10 times more carcinoembryonic antigen was
produced in cells treated with saponins. However, at all the
concentrations used, saponins did not induce apoptosis, although there
were slight decreases in apoptotic activity in cells treated with 240
and 600 ppm of soybean saponins. These results suggest that crude
soybean saponin extract effectively suppresses PKC activation and
induces differentiation, which possibly mediate the growth inhibition of
tumor cells. Further experiments, including preclinical efficacy
studies, are required to fully evaluate soybean saponins for their
chemopreventive properties.
3
UI - 11916153
AU - Winawer SJ; Zauber AG
TI -
The advanced adenoma as the primary target of screening.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):1-9, v
AD - Department of Medicine, Memorial Sloan-Kettering Cancer Center, and
Weill Medical College of Cornell University, New York, New York 10021,
USA. winawers@mskcc.org
The advanced adenoma bridges benign and malignant states and may be the
most valid neoplastic surrogate marker for present and future colorectal
cancer risk. We define the advanced adenoma as an adenoma with
significant villous features (>25%), size of 1.0 cm or more, high-grade
dysplasia, or early invasive cancer. Prevention studies should
demonstrate a high efficacy in reducing the number of advanced adenomas.
We should use the advanced adenoma in the evaluation of new screening
technology, nutritional interventions, and chemoprevention agents
because the advanced adenoma is a more desirable target for screening
efficacy than is the more uncommon but life-threatening cancer stage or
the more common but early, less significant small adenoma stage.
4
UI - 11916155
AU - van Stolk RU
TI -
Familial and inherited colorectal cancer: endoscopic screening and
surveillance.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):111-33
AD - Department of Medicine, Northwestern University School of Medicine,
Chicago, Illinois, USA.
Familial risk of colorectal cancer is very common. The high-risk
inherited syndromes are well described and much is known about the
genetics and the effectiveness of registration, endoscopic surveillance,
and appropriate intervention in these patients. The inherited syndromes,
however, are extremely rare. There is a large group of patients in our
population who can benefit from risk stratification based on the number
of their relatives with colon cancer or adenomas and the age at which
those relatives developed neoplasm. The GI endoscopist has a vital role
in recommending and providing colonoscopic screening for this large
group of patients.
5
UI - 11916157
AU - Wender RC
TI -
Barriers to screening for colorectal cancer.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):145-70
AD - Department of Family Medicine, Thomas Jefferson University,
Philadelphia, Pennsylvania, USA.
Rapidly growing interest in colon cancer screening is a crucial first
step to identifying and reducing many of the barriers that impede
population screening for this common disease. Promoting screening
demands health care policy change to increase the percentage of
Americans with insurance coverage that includes a colon cancer screening
benefit. A systematic approach to screening with invitations that come
from a clinician are likely to be the most effective way to prompt more
individuals to be screened. Awareness campaigns and patient educational
aids, including decision tools, implemented in multiple sites, such as
worksites, community centers, health care systems, and physician
offices, increase the percent of eligible Americans who understand their
personal risk, the need for screening, and the options available to
them.
6
UI - 11916158
AU - Feld AD
TI -
Medicolegal implications of colon cancer screening.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):171-9, viii-ix
AD - Group Health Cooperative of Puget Sound, and Department of Medicine,
University of Washington, Seattle, USA.
The treatment of colon cancer is a significant source of malpractice
liability. Physicians are justifiably concerned about malpractice
exposure as personal injury attorneys investigate standard and novel
malpractice theories and claims. With the general acceptance of the
importance of screening for colon cancer, screening for colon cancer is
now defined as the standard of care. This has opened up a previously
neglected area of malpractice liability. Physicians need to understand
the sources of malpractice risk and risk-management strategies related
to these sources to reduce their exposure to liability suits in this
area. This article outlines these sources evolving from the tort of
negligence, including the duty to provide care, practicing below the
standards of care, the cause of the harm, and the actual establishment
of harm. The concept of vicarious liability and its relationship to the
tort of negligence also are discussed. This presentation is developed
within the context of a risk-management approach to assist physicians in
developing a preventive approach to malpractice liability.
7
UI - 11916159
AU - Levin TR; Palitz AM
TI -
Flexible sigmoidoscopy: an important screening option for average-risk
individuals.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):23-40, vi
AD - Department of Gastroenterology, Kaiser Permanente Medical Center, Walnut
Creek, California, USA. Theodore.Levin@kp.org
Colorectal cancer screening techniques should be effective, acceptable
to patients, affordable, widely available, and safe. For average-risk
adults aged more than 50 years who do not have significant colorectal
symptoms, significant family history, or significant predisposing
conditions, flexible sigmoidoscopy is an important option for reducing
the risk for colorectal cancer, meeting all criteria for an effective
and feasible screening modality. This article discusses evidence
supporting flexible sigmoidoscopy, practical issues in implementation,
and current controversies.
8
UI - 11916161
AU - Fletcher RH
TI -
Rationale for combining different screening strategies.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):53-63
AD - Department of Ambulatory Care and Prevention, Harvard Medical School and
Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
It is generally accepted that screening programs should be quite safe,
and that the benefits should substantially outweigh the harms. As
Cochrane and Holland stated: We believe that there is an ethical
difference between everyday medical practice and screening. If a patient
asks a medical practitioner for help, the doctor does the best he can.
He is not responsible for defects in medical knowledge. If, however, the
practitioner initiates screening procedures he is in a very different
situation. He should, in our view, have conclusive evidence that
screening alters the natural history of disease in a significant
proportion of those screened. If this is so, one should recommend the
combination over either test alone only if there is sufficient evidence
that the combination is more effective and no more dangerous. There is a
difference of opinion over whether the evidence, which is certainly not
strong, is nevertheless sufficient. This poses a dilemma. Many expert
groups prefer that screening for colorectal cancer be done with both
FOBT and sigmoidoscopy rather than either alone. Yet, the strength of
the evidence for additional effectiveness, and information on the
magnitude of that effect if it is present, is substantially less than
for the individual tests. This being the case, the author believes that
it is premature to advocate the combination over either test alone,
especially when the most pressing national priority in colorectal cancer
screening is to get a large proportion of the adult population to be
screened at all.
9
UI - 11916162
AU - Rex DK
TI -
Rationale for colonoscopy screening and estimated effectiveness in
clinical practice.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):65-75
AD - Department of Medicine, Indiana University School of Medicine and
Indiana University Hospital, Indianapolis 46202, USA.
Colonoscopy screening has the highest anticipated level of effectiveness
of the available colorectal cancer screening techniques. Its long-term
cost-effectiveness is also comparable with or superior to other
modalities. Evidence for the expected reduction in colorectal cancer
incidence and mortality varies with colonoscopy screening from 50% to
90%, for reasons that are not fully understood. Maintaining a high
standard of performance is critical with regard to achieving the highest
level of effectiveness possible.
10
UI - 11916163
AU - Nelson DB
TI -
Technical assessment of direct colonoscopy screening: procedural
success, safety, and feasibility.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):77-84
AD - Minneapolis Veterans Affairs Medical Center, and the Department of
Medicine, University of Minnesota, 55417, USA. nelso195@tc.umn.edu
Colonoscopy, when performed by adequately trained physicians, is a safe
and effective procedure for colorectal cancer screening. To realize the
benefits of colonoscopic screening of the general population for
colorectal cancer, it is imperative that physicians performing this
procedure receive appropriate training to maintain the highest standards
of patient care.
11
UI - 11916164
AU - Hawes RH
TI -
Does virtual colonoscopy have a major role in population-based
screening?
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):85-91
AD - Digestive Disease Center, Division of Gastroenterology and Hepatology,
Medical University of South Carolina, Charleston, USA. hawesr@musc.edu
In summary, technical advances in the performance of VC are occurring at
a very rapid pace. These technical improvements will undoubtedly improve
the polyp detection rate and reduce false-positive and false-negative
examinations. The concept of VC is clearly attractive and the general
public is enamored with everything that has an association with virtual
reality. As other articles in this issue have revealed, there are many
techniques in development to help stratify patients at risk for colon
cancer. As we begin to focus our health care resources on those at
highest risk, the less need there is for inexpensive, broadly based
screening techniques. Clearly, those patients at high risk for having
polyps are better served by colonoscopy because of its therapeutic
potential. That being said, in the view of this author, if a virtual
preparation can be achieved and the cost of VC can be kept relatively
low, then this technique will become part of our mainstream clinical
practice. If an immaculate colon preparation must be performed and if
the costs reflect standard abdominal and pelvic CT rather than a special
reduced cost for VC, then it is doubtful that there will be any
significant impact from this technology
12
UI - 11916165
AU - Provenzale D
TI -
Cost-effectiveness of screening the average-risk population for
colorectal cancer.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):93-109
AD - Gastrointestinal Outcomes Research Program, Duke University Medical
Center, Durham, North Carolina 27710, USA. prove002@mc.duke.edu
This article reviews several of the recent models addressing the
cost-effectiveness of colorectal cancer screening in the average-risk
individual (Table 1). How can clinicians and policy makers use this
information for decision making regarding colorectal cancer screening?
The cost-effectiveness ratios reported by themselves do not identify
cost-effective practices. They must be placed in a decision context that
is expressed in one of two forms. In the first form, an explicit
threshold or maximum amount that a policy maker is willing to spend is
stated (e.g., $40,000 per LY gained, as has been quoted as an acceptable
amount for a prevention program). In the second form of decision
context, a list of medical practices and their associated
cost-effectiveness ratios, also known as a league table (Table 2) is
used as a basis for comparison with the practice under evaluation (e.g.,
colorectal cancer screening). The practice with the lowest
cost-effectiveness ratio is the most cost-effective practice on the
list. Practices with lower cost-effectiveness ratios are considered
cost-effective compared with those with higher ratios. Table 2 lists
incremental cost-effectiveness ratios for common medical practices. The
models discussed in this article suggested that colorectal cancer
screening using annual FOBT, flexible sigmoidoscopy at 3 or 5 years, the
combination of FOBT and flexible sigmoidoscopy, barium enema,
colonoscopy, and even virtual colonoscopy had incremental
cost-effectiveness ratios ranging from $6300 to $92,900 per LY saved
with most of the cost-effectiveness ratio ranging from $10,000 to
$40,000 per LY saved. These ratios are similar to the cost of another
widely accepted practice, breast cancer screening with annual
mammography in women age 50 and older ($22,000 per LY gained).
Colorectal cancer screening with any of the modalities discussed is
considered less cost-effective than screening for hemochromatosis, which
has an incremental cost-effectiveness ratio of $3665 per LY saved. Based
on these ratios, however, screening for colorectal cancer is considered
cost-effective compared with cervical cancer screening in women age 20
and older with pap smear every 3 years, which has an incremental
cost-effectiveness ratio of $250,000 per LY gained. The clinician can
use these incremental cost-effectiveness ratios to evaluate the risks
and benefits of alternative practices for the individual, and the policy
maker with a limited health care budget can use these ratios to set
priorities for funding based on the costs and the expected gains in life
expectancy for colorectal cancer screening and for alternative health
care programs.
13
UI - 11448589
AU - Akoglu B; Faust D; Milovic V; Stein J
TI -
Folate and chemoprevention of colorectal cancer: Is
5-methyl-tetrahydrofolate an active antiproliferative agent in
folate-treated colon-cancer cells?
SO - Nutrition 2001 Jul-Aug;17(7-8):652-3
AD - Second Department of Medicine and Gastroenterology, Johann Wolfgang
Goethe University, Frankfurt, Germany.
14
UI - 11902546
AU - Burton A
TI -
Vitamine D derivatives convert colon cancer cells.
SO - Lancet Oncol 2001 Oct;2(10):593
15
UI - 11935094
AU - Plesch FN; Kubicka S; Manns MP
TI -
Prevention of hepatocellular carcinoma in chronic liver disease:
molecular markers and clinical implications.
SO - Dig Dis 2001;19(4):338-44
AD - Department of Gastroenterology and Hepatology, Medizinische Hochschule
Hannover, Germany.
The development of hepatocellular carcinoma is generally preceded by
chronic liver damage leading to cirrhosis. Prevention of chronic liver
diseases can decrease the incidence of hepatic cancer impressively. Many
recent investigations have also explored the power of secondary and
tertiary prevention in established liver cirrhosis. Screening programs
for patients at high risk, antiviral treatment of patients with
progressed hepatitis, and adjuvant interventions after curative
resection are some of the approaches. However, the cost effectiveness
and benefits of such procedures and the prognosis is also dependent on
the remaining liver function, there is no consensus to date on how
patients should be handled. In the future molecular markers and
prognostic scores may help better define the group at risk of
developing. To give a perspective to these patients, it is necessary to
improve the treatment of hepatocellular carcinoma as well as cirrhosis.
Copyright 2002 S. Karger AG, Basel
16
UI - 11940443
AU - Barrett JR
TI -
Cancer. Plants provide prevention.
SO - Environ Health Perspect 2002 Apr;110(4):A180
17
UI - 11937993
AU - Saurin JC
TI -
[Flat adenomas: should we reconsider colonic endoscopy and colorectal
cancer prevention?]
SO - Ann Pathol 2002 Feb;22(1):6-8
18
UI - 11977538
AU - Ishikawa H
TI -
[Cancer prevention in familial cancer]
SO - Gan To Kagaku Ryoho 2002 Apr;29(4):545-9
AD - Department of Cancer Epidemiology, Osaka Medical Center for Cancer and
Cardiovascular Diseases, 3-3 Nakamichi, 1-Chome, Higashinari-ku, Osaka
537-8511, Japan.
We established a protocol for and will conduct an interventional
randomized controlled trial for the prevention of colorectal cancer. The
subjects will be 100 patients with hereditary non-polyposis colorectal
cancer. Two regimens were formulated for the prevention of colorectal
cancer. Regimen A is dietary guidance and ingestion of aged garlic
extract (AGE) capsules, and regimen B is dietary guidance and
non-function capsules. The main end point of the trial is number and
size of colorectal adenomas after 2 years. Subject recruiting was
started in March, 2002. The trial will be completed in September, 2005.
19
UI - 11982682
AU - Jagadeesan UB
TI -
An incentive to start hormone replacement: the effect of postmenopausal
hormone replacement therapy on the risk of colorectal cancer.
SO - J Am Geriatr Soc 2002 Apr;50(4):768-70
AD - Department of Medicine, Albert Einstein College of Medicine, Montefiore
Medical Center, Bronx, NY, USA.
20
UI - 11952580
AU - Kubo S; Nishiguchi S; Hirohashi K; Tanaka H; Shuto T; Kinoshita H
TI -
Randomized clinical trial of long-term outcome after resection of
hepatitis C virus-related hepatocellular carcinoma by postoperative
interferon therapy.
SO - Br J Surg 2002 Apr;89(4):418-22
AD - Second Department of Surgery, Osaka City University Medical School,
Osaka, Japan. m7696493@msic.med.osaka-cu.ac.jp
BACKGROUND: Interferon therapy seems to decrease the incidence of
recurrence after resection of hepatitis C virus (HCV)-related
hepatocellular carcinoma (HCC). Effects of postoperative interferon
therapy on the survival rate after resection of such HCC are still
unclear. METHODS: A prospective randomized clinical trial of
postoperative interferon therapy was performed. Thirty men were
allocated randomly after liver resection to an interferon-alpha group
(15 patients) or a control group. Patients in the interferon group
received interferon-alpha 6 MIU intramuscularly every day for 2 weeks,
then three times a week for 14 weeks and finally twice a week for 88
weeks. RESULTS: The response to interferon was complete in two patients,
there was a biochemical response in six patients and no response in
seven patients. Interferon administration was not completed in three
patients because of adverse events. Liver function did not change or
worsened after operation in the control group, and did not change or
improved in the interferon group. The cumulative survival rate was
higher in the interferon group than in the control group (P = 0.041).
CONCLUSION: Postoperative interferon therapy seems to improve the
outcome after resection of HCV-related HCC.
21
UI - 11976170
AU - Flood A; Velie EM; Chaterjee N; Subar AF; Thompson FE; Lacey JV Jr;
TI -
Schairer C; Troisi R; Schatzkin A
Fruit and vegetable intakes and the risk of colorectal cancer in the
Breast Cancer Detection Demonstration Project follow-up cohort.
SO - Am J Clin Nutr 2002 May;75(5):936-43
AD - Division of Cancer Epidemiology and Genetics, the National Cancer
Institute, Bethesda, MD 20892, USA. flooda@exchange.nih.gov
BACKGROUND: Recent findings have cast doubt on the hypothesis that high
intakes of fruit and vegetables are associated with a reduced risk of
colorectal cancer. OBJECTIVE: In a large prospective cohort of women, we
examined the association between fruit and vegetable intakes and
colorectal cancer. DESIGN: Between 1987 and 1989, 45490 women with no
history of colorectal cancer satisfactorily completed a 62-item
Block-National Cancer Institute food-frequency questionnaire. During
386142 person-years of follow-up, 314 women reported incident colorectal
cancer, searches of the National Death Index identified an additional
106 colorectal cancers, and a match with state registries identified
another 65 colorectal cancers for a total of 485 cases. We used Cox
proportional hazards regression analysis to estimate the relative risks
(RRs) and 95% CIs in both energy-adjusted and fully adjusted models.
RESULTS: In models using the multivariate nutrient-density model of
energy adjustment, RRs for increasing quintile of fruit consumption
indicated no significant association with colorectal cancer [RR (95%
CI)]: 1.00 (reference), 0.94 (0.70, 1.26), 0.85 (0.63, 1.15), 1.07
(0.81, 1.42), and 1.09 (0.82, 1.44). For vegetable consumption, there
was also no significant association in the multivariate nutrient-density
model with increasing quintiles of consumption: 1.00 (reference), 0.77
(0.58, 1.02), 0.83 (0.63, 1.10), 0.90 (0.69, 1.19), and 0.92 (0.70,
1.22). Additionally, 3 alternative models of energy adjustment showed no
significant association between increases in vegetable intake and the
risk of colorectal cancer. CONCLUSION: Although the limitations of our
study design and data merit consideration, this investigation provides
little evidence of an association between fruit and vegetable intakes
and colorectal cancer.
22
UI - 12023992
AU - Kauff ND; Satagopan JM; Robson ME; Scheuer L; Hensley M; Hudis CA; Ellis
TI -
NA; Boyd J; Borgen PI; Barakat RR; Norton L; Castiel M; Nafa K; Offit K
Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2
mutation.
SO - N Engl J Med 2002 May 23;346(21):1609-15
AD - Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, New
York 10021, USA.
BACKGROUND: Risk-reducing salpingo-oophorectomy is often considered by
carriers of BRCA mutations who have completed childbearing. However,
there are limited data supporting the efficacy of this approach. We
prospectively compared the effect of risk-reducing salpingo-oophorectomy
with that of surveillance for ovarian cancer on the incidence of
subsequent breast cancer and BRCA-related gynecologic cancers in women
with BRCA mutations. METHODS: All women with BRCA1 or BRCA2 mutations
identified during a six-year period were offered enrollment in a
prospective follow-up study. A total of 170 women 35 years of age or
older who had not undergone bilateral oophorectomy chose to undergo
either surveillance for ovarian cancer or risk-reducing
salpingo-oophorectomy. Follow-up involved an annual questionnaire,
telephone contact, and reviews of medical records. The time to cancer in
the two groups was compared by Kaplan-Meier analysis and a Cox
proportional-hazards model. RESULTS: During a mean follow-up of 24.2
months, breast cancer was diagnosed in 3 of the 98 women who chose
risk-reducing salpingo-oophorectomy and peritoneal cancer was diagnosed
in 1 woman in this group. Among the 72 women who chose surveillance,
breast cancer was diagnosed in 8, ovarian cancer in 4, and peritoneal
cancer in 1. The time to breast cancer or BRCA-related gynecologic
cancer was longer in the salpingo-oophorectomy group, with a hazard
ratio for subsequent breast cancer or BRCA-related gynecologic cancer of
0.25 (95 percent confidence interval, 0.08 to 0.74). CONCLUSIONS:
Salpingo-oophorectomy in carriers of BRCA mutations can decrease the
risk of breast cancer and BRCA-related gynecologic cancer.
23
UI - 12023993
AU - Rebbeck TR; Lynch HT; Neuhausen SL; Narod SA; Van't Veer L; Garber JE;
TI -
Evans G; Isaacs C; Daly MB; Matloff E; Olopade OI; Weber BL; The
Prevention and Observation of Surgical End Points Study Group
Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations.
SO - N Engl J Med 2002 May 23;346(21):1616-22
AD - Center for Clinical Epidemiology and Biostatistics, University of
Pennsylvania School of Medicine, Philadelphia 19104-6021, USA.
trebbeck@cceb.med.upenn.edu
BACKGROUND: Data concerning the efficacy of bilateral prophylactic
oophorectomy for reducing the risk of gynecologic cancer in women with
BRCA1 or BRCA2 mutations are limited. We investigated whether this
procedure reduces the risk of cancers of the coelomic epithelium and
breast in women who carry such mutations. METHODS: A total of 551 women
with disease-associated germ-line BRCA1 or BRCA2 mutations were
identified from registries and studied for the occurrence of ovarian and
breast cancer. We determined the incidence of ovarian cancer in 259
women who had undergone bilateral prophylactic oophorectomy and in 292
matched controls who had not undergone the procedure. In a subgroup of
241 women with no history of breast cancer or prophylactic mastectomy,
the incidence of breast cancer was determined in 99 women who had
undergone bilateral prophylactic oophorectomy and in 142 matched
controls. The length of postoperative follow-up for both groups was at
least eight years. RESULTS: Six women who underwent prophylactic
oophorectomy (2.3 percent) received a diagnosis of stage I ovarian
cancer at the time of the procedure; two women (0.8 percent) received a
diagnosis of papillary serous peritoneal carcinoma 3.8 and 8.6 years
after bilateral prophylactic oophorectomy. Among the controls, 58 women
(19.9 percent) received a diagnosis of ovarian cancer, after a mean
follow-up of 8.8 years. With the exclusion of the six women whose cancer
was diagnosed at surgery, prophylactic oophorectomy significantly
reduced the risk of coelomic epithelial cancer (hazard ratio, 0.04; 95
percent confidence interval, 0.01 to 0.16). Of 99 women who underwent
bilateral prophylactic oophorectomy and who were studied to determine
the risk of breast cancer, breast cancer developed in 21 (21.2 percent),
as compared with 60 (42.3 percent) in the control group (hazard ratio,
0.47; 95 percent confidence interval, 0.29 to 0.77). CONCLUSIONS:
Bilateral prophylactic oophorectomy reduces the risk of coelomic
epithelial cancer and breast cancer in women with BRCA1 or BRCA2
mutations.
24
UI - 11992750
AU - Rex DK
TI -
Screening for colon cancer and evaluation of chemoprevention with
coxibs.
SO - J Pain Symptom Manage 2002 Apr;23(4 Suppl):S41-50
AD - Department of Medicine, Indiana University School of Medicine,
Indianapolis, IN 46202, USA.
Although colorectal cancer is one of the most preventable forms of
visceral cancer, it remains the second leading cause of cancer death in
the United States. Most colorectal cancers are believed to arise from
adenomatous polyps, premalignant mucosal masses that account for up to
two thirds of colorectal polyps. Early identification and removal of
adenomas prevent the development of colorectal cancer. Colonoscopy has
emerged as the dominant method for evaluating symptomatic patients with
colorectal cancer and for surveillance of patients with previous colon
polyps or cancer. In the United States, fecal occult blood testing and
flexible sigmoidoscopy are the most commonly used screening methods in
average-risk persons, although there is an emerging trend toward the use
of colonoscopy. For both screening and surveillance, the type of
screening test used and the intervals at which it is performed are based
on risk stratification, which also serves as the basis for selecting
potential candidates for chemoprevention. Because colonoscopy, like most
screening procedures, has several disadvantages, including risk of
perforation and bleeding and an inherent "miss rate," alternative
methods of prevention are being explored. A variety of agents with
potential chemopreventive benefits have been identified, including
cyclooxygenase (COX)-2-specific inhibitors (coxibs) even though these
agents have not been approved for this use in the United States. COX-2
is overexpressed in colonic adenomas and cancers, and its inhibition has
been shown to produce regression of polyps in familial adenomatous
polyposis. Nonselective COX inhibition with nonsteroidal
anti-inflammatory drugs (NSAIDs) has been consistently associated with
reductions in the risk of mortality and the incidence of colorectal
adenomas and cancers in case-control studies. Thus, selective COX-2
inhibition is a potential method of risk reduction in high-risk
screening and surveillance groups, and large-scale trials of coxibs for
the prevention of recurrence of adenomas after polypectomy are currently
underway.
25
UI - 12019405
AU - Kunisaki C; Shimada H; Nomura M; Akiyama H; Takahashi M; Matsuda G
TI -
Lack of efficacy of prophylactic continuous hyperthermic peritoneal
perfusion on subsequent peritoneal recurrence and survival in patients
with advanced gastric cancer.
SO - Surgery 2002 May;131(5):521-8
AD - Second Department of Surgery, Yokohama City University, School of
Medicine, Yokohama, Japan.
BACKGROUND: Peritoneal recurrence is a major cause of death in advanced
gastric cancer. Although many kinds of chemotherapy intended to prevent
peritoneal recurrence of gastric cancer have been evaluated, few have
been successful. Few studies have assessed the clinical significance of
continuous hyperthermic peritoneal perfusion in peritoneal recurrence.
METHODS: From 1992 to 1999, a total of 124 patients with advanced
gastric cancer with tumors invading deeper than the serosa but with no
peritoneal metastasis underwent potentially curative gastrectomy and
were enrolled in this study. Prophylactic continuous hyperthermic
peritoneal perfusion (P-CHPP) was performed in 45 patients younger than
65 years old and without comorbidity who gave informed consent.
Seventy-nine patients who did not meet the inclusion criteria
represented the control group. After reconstruction of the alimentary
tract, P-CHPP was carried out for 40 minutes with 150 mg cisplatin, 15
mg mitomycin C, and 150 mg etoposide in 5 to 6 L physiologic saline
maintained at 42 degrees C to 43 degrees C. The surgical results,
recurrent pattern, and postoperative morbidity were assessed by
univariate and multivariate analysis. RESULTS: When compared with
patients not undergoing P-CHPP, patients treated by P-CHPP had higher
incidences of respiratory failure (73% vs 19%; P <.0001) and renal
failure (7% vs 0%; P <.03). Neither 5-year survival (49% vs 56%) nor the
patterns of recurrence (peritoneal, hematogenous, and lymphatic) were
affected by P-CHPP. CONCLUSIONS: P-CHPP by our methods had no efficacy
as prophylactic treatment for peritoneal recurrence induced by gastric
cancer. New therapeutic strategies, such as chemosensitivity assessment,
are necessary to obtain good therapeutic results with CHPP.
26
UI - 11857050
AU - Negri E; La Vecchia C; Franceschi S
TI -
Relations between vegetable, fruit and micronutrient intake.
Implications for odds ratios in a case-control study.
SO - Eur J Clin Nutr 2002 Feb;56(2):166-70
AD - Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
evanegri@marionegri.it
OBJECTIVE: To investigate whether the protection observed for some
micronutrients, such as beta-carotene, in several observational studies
may simply reflect vegetable and fruit intake. DESIGN: A case-control
study conducted in Italy. SUBJECTS: The subjects were 1225 colon cancer
patients, 728 rectal cancer patients and 4154 hospital controls.
RESULTS: For the 16 micronutrients considered, the more closely a
micronutrient was correlated with total vegetable and fruit intake, the
more it appeared protective against colorectal cancer. CONCLUSION: When
studying the effect of a nutrient on disease risk in an observational
setting, its relation to other nutrients and foods must be taken into
account.
27
UI - 11905744
AU - Habeck M
TI -
Major campaign to raise colon cancer awareness in Germany.
SO - Lancet Oncol 2001 Jun;2(6):328
28
UI - 12019505
AU - Immanuel A; Lamb PJ; Wayman J; Preston S; Griffin SM
TI -
Prevention of the neoplastic progression of Barrett's oesophagus by
argon beam plasma ablation (Br J Surg 2001;88:1357-62).
SO - Br J Surg 2002 May;89(5):626; discussion 626
29
UI - 11987643
AU - DeDecker L
TI -
When colon cancer runs in the family.
SO - Mich Nurse 2001 Aug;74(7):24, 31
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