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Validity of Administrative Databases in Comparison to Medical Charts for Breast Cancer Treatment Data. 管理数据库与医学图表比较乳腺癌治疗数据的有效性。
IF 1.8 Q2 Medicine Pub Date : 2018-05-14 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9218595
Ashini Weerasinghe, Courtney R Smith, Vicky Majpruz, Anjali Pandya, Kristina M Blackmore, Claire M B Holloway, Roanne Segal-Nadlere, Cathy Paroschy Harris, Ashley Hendry, Amanda Hey, Anat Kornecki, George Lougheed, Barbara-Anne Maier, Patricia Marchand, David McCready, Carol Rand, Simon Raphael, Neelu Sehgal, Anna M Chiarelli

Objective: Medical chart abstraction is the gold standard for collecting breast cancer treatment data for monitoring and research. A less costly alternative is the use of administrative databases. This study will evaluate administrative data in comparison to medical charts for breast cancer treatment information.

Study design and setting: A retrospective cohort design identified 2,401 women in the Ontario Breast Screening Program diagnosed with invasive breast cancer from 2006 to 2009. Treatment data were obtained from the Activity Level Reporting and Canadian Institute of Health Information databases. Medical charts were abstracted at cancer centres. Sensitivity, specificity, positive and negative predictive value, and kappa were calculated for receipt and type of treatment, and agreement was assessed for dates. Logistic regression evaluated factors influencing agreement.

Results: Sensitivity and specificity for receipt of radiotherapy (92.0%, 99.3%), chemotherapy (77.7%, 99.2%), and surgery (95.8%, 100%) were high but decreased slightly for specific radiotherapy anatomic locations, chemotherapy protocols, and surgeries. Agreement increased by radiotherapy year (trend test, p < 0.0001). Stage II/III compared to stage I cancer decreased odds of agreement for chemotherapy (OR = 0.66, 95% CI: 0.48-0.91) and increased agreement for partial mastectomy (OR = 3.36, 95% CI: 2.27-4.99). Exact agreement in treatment dates varied from 83.0% to 96.5%.

Conclusion: Administrative data can be accurately utilized for future breast cancer treatment studies.

目的:医学图表抽象是收集乳腺癌治疗数据进行监测和研究的金标准。一种成本较低的替代方法是使用管理数据库。本研究将评估管理数据与医学图表对乳腺癌治疗信息的比较。研究设计和背景:一项回顾性队列设计确定了2006年至2009年安大略省乳腺筛查项目中诊断为浸润性乳腺癌的2401名妇女。治疗数据来自活动水平报告和加拿大卫生信息研究所的数据库。癌症中心摘录了医学图表。计算接受治疗和治疗类型的敏感性、特异性、阳性和阴性预测值以及kappa,并评估日期的一致性。Logistic回归评价影响一致性的因素。结果:放疗(92.0%,99.3%)、化疗(77.7%,99.2%)和手术(95.8%,100%)的敏感性和特异性较高,但对特定的放疗解剖部位、化疗方案和手术的敏感性和特异性略有下降。一致性随着放疗年份的增加而增加(趋势检验,p < 0.0001)。与I期癌症相比,II/III期癌症同意化疗的几率降低(OR = 0.66, 95% CI: 0.48-0.91),部分乳房切除术的几率增加(OR = 3.36, 95% CI: 2.27-4.99)。治疗日期的确切一致性从83.0%到96.5%不等。结论:行政数据可以准确地用于未来的乳腺癌治疗研究。
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引用次数: 2
A Case-Control Study of Risk Factors for Salivary Gland Cancer in Canada 加拿大涎腺癌危险因素的病例对照研究
IF 1.8 Q2 Medicine Pub Date : 2017-01-04 DOI: 10.1155/2017/4909214
S. Pan, M. de Groh, H. Morrison
Aim. To assess the effect of various lifestyle risk factors on the risk of salivary gland cancer in Canada using data from a population-based case-control study. Methods. Data from a population-based case-control study of 132 incident cases of salivary gland cancer and 3076 population controls were collected through self-administered questionnaire and analysed using unconditional logistic regression. Results. Four or more servings/week of processed meat product was associated with an adjusted odds ratio (OR) and corresponding 95% confidence interval (CI) of 1.62 (1.02–2.58). Nonsignificantly increased ORs were also related to obesity, >7 drinks/week of alcohol consumption, and occupational exposure to radiation. Furthermore, nonsignificantly decreased ORs were found to be associated with high education level (>12 years) (OR = 0.65), high consumption of spinach/squash (OR = 0.62) and all vegetables/vegetable juices (OR = 0.75), and >30 sessions/month of recreational physical activity (OR = 0.78). Conclusions. This study suggests positive associations with consumption of processed meat, smoking, obesity, alcohol drinking, and occupational exposure to radiation as well as negative associations with higher education, consumption of spinach/squash, and physical activity, which suggest a role of lifestyle factors in the etiology of salivary gland cancer. However, these findings were based on small number of cases and were nonsignificant. Further larger studies are warranted to confirm our findings.
的目标。利用一项基于人群的病例对照研究的数据,评估各种生活方式风险因素对加拿大唾液腺癌风险的影响。方法。通过问卷调查收集了132例涎腺癌病例和3076例人群对照的数据,并采用无条件logistic回归进行分析。结果。每周食用四份或四份以上的加工肉制品与调整后的优势比(or)和相应的95%置信区间(CI)相关,其值为1.62(1.02-2.58)。无显著性增加的ORs还与肥胖、每周饮酒70杯和职业性辐射暴露有关。此外,发现高教育水平(>12年)(OR = 0.65)、大量食用菠菜/南瓜(OR = 0.62)和所有蔬菜/蔬菜汁(OR = 0.75)以及>30次/月的娱乐性体育活动(OR = 0.78)与ORs的无显著降低相关。结论。这项研究表明,与食用加工肉类、吸烟、肥胖、饮酒和职业辐射暴露呈正相关,与高等教育、食用菠菜/南瓜和体育锻炼呈正相关,这表明生活方式因素在唾液腺癌的病因中起着重要作用。然而,这些发现是基于少数病例,没有显著意义。有必要进行更大规模的研究来证实我们的发现。
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引用次数: 24
Cancer Prevention in Low- and Middle-Income Countries. 低收入和中等收入国家的癌症预防。
IF 1.8 Q2 Medicine Pub Date : 2017-01-01 Epub Date: 2017-02-22 DOI: 10.1155/2017/8312064
Subhojit Dey, Preet K Dhillon, Preetha Rajaraman
Cancer is a rising problem across the world with a 33% increase in global cases of cancer between 2005 and 2015 [1]. The increase has been maximum in countries with the lowest development [1]. While LMICs bear a major share of the burden of cancer [1–3], very few LMICs have a comprehensive cancer prevention strategy in place.This leads to a high proportion of patients presenting at tertiary care centres at late stages of cancer, when treatment is most difficult and costly and survival is poor [4]. In the absence of adequate treatment capacity in most LMICs, patients presenting at later stages significantly increase the burden of disease. Lack of palliative care [5] compounds this situation further resulting in anunfortunate scenariowhere a diagnosis of cancer is equated with death in most LMICs. With reducing levels of infectious diseases and rising life expectancies, LMICs are recognizing that cancer needs to become a health priority. However, the essential steps required to prevent cancer and avoid the later consequences are still lacking emphasis. With the above scenario in mind, we had issued a call for papers that focused on cancer prevention in LMICs. Overall, it was observed that research on cancer and especially cancer prevention in LMICs was limited [6]. Among the cancer research that is being done in LMICs, a lot of research is not of good quality. Also, most of the focus is currently on building capacity and conducting research related to cancer treatment, and cancer prevention takes a back seat, for cancer prevention requires not only facilities and human resources on the health system side but also awareness and the will and ability to pay for preventive services on the population side. Given the situation in most LMICs, both sides fall short of reaching a point where cancer prevention can be a realistic scenario. Regarding this, it is important to note the recommendations of the Breast Health Global Initiative (BHGI) which has created guidelines for breast cancer prevention while considering the economic situation of a particular nation [7]. We need to focus more on cancer prevention in LMICs, and while the job of the health providers and researchers including thosewho contributed to this special issue is commendable, there is immense scope for more to be done.
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引用次数: 3
Racial and Socioeconomic Disparities Are More Pronounced in Inflammatory Breast Cancer Than Other Breast Cancers. 种族和社会经济差异在炎性乳腺癌中比其他乳腺癌更明显。
IF 1.8 Q2 Medicine Pub Date : 2017-01-01 Epub Date: 2017-08-15 DOI: 10.1155/2017/7574946
Ryan A Denu, John M Hampton, Adam Currey, Roger T Anderson, Rosemary D Cress, Steven T Fleming, Joseph Lipscomb, Xiao-Cheng Wu, J Frank Wilson, Amy Trentham-Dietz

Inflammatory breast cancer (IBC) is a rare yet aggressive form of breast cancer. We examined differences in patient demographics and outcomes in IBC compared to locally advanced breast cancer (LABC) and all other breast cancer patients from the Breast and Prostate Cancer Data Quality and Patterns of Care Study (POC-BP), containing information from cancer registries in seven states. Out of 7,624 cases of invasive carcinoma, IBC and LABC accounted for 2.2% (N = 170) and 4.9% (N = 375), respectively. IBC patients were more likely to have a higher number (P = 0.03) and severity (P = 0.01) of comorbidities than other breast cancer patients. Among IBC patients, a higher percentage of patients with metastatic disease versus nonmetastatic disease were black, on Medicaid, and from areas of higher poverty and more urban areas. Black and Hispanic IBC patients had worse overall and breast cancer-specific survival than white patients; moreover, IBC patients with Medicaid, patients from urban areas, and patients from areas of higher poverty and lower education had worse outcomes. These data highlight the effects of disparities in race and socioeconomic status on the incidence of IBC as well as IBC outcomes. Further work is needed to reveal the causes behind these disparities and methods to improve IBC outcomes.

炎症性乳腺癌(IBC)是一种罕见但具有侵袭性的乳腺癌。我们检查了IBC患者的人口统计学和结果与局部晚期乳腺癌(LABC)和所有其他乳腺癌患者相比的差异,这些患者来自乳腺癌和前列腺癌数据质量和护理模式研究(POC-BP),包含来自七个州癌症登记处的信息。7624例浸润性癌中,IBC和LABC分别占2.2% (N = 170)和4.9% (N = 375)。IBC患者的合并症数量(P = 0.03)和严重程度(P = 0.01)均高于其他乳腺癌患者。在IBC患者中,患有转移性疾病的患者比例高于非转移性疾病的患者是黑人,接受医疗补助,来自高度贫困地区和更多的城市地区。黑人和西班牙裔IBC患者的总体生存率和乳腺癌特异性生存率低于白人患者;此外,接受医疗补助的IBC患者、来自城市地区的患者以及来自高度贫困和低教育程度地区的患者的预后更差。这些数据强调了种族和社会经济地位差异对IBC发病率和IBC结局的影响。需要进一步的工作来揭示这些差异背后的原因和改善IBC结果的方法。
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引用次数: 8
Insurance Status Is Related to Receipt of Therapy and Survival in Patients with Early-Stage Pancreatic Exocrine Carcinoma. 保险状况与早期胰腺外分泌癌患者接受治疗和生存相关。
IF 1.8 Q2 Medicine Pub Date : 2017-01-01 Epub Date: 2017-04-10 DOI: 10.1155/2017/4354592
Emily Boevers, Bradley D McDowell, Sarah L Mott, Anna M Button, Charles F Lynch

Objectives. The study objective was to determine how insurance status relates to treatment receipt and overall survival for patients with early-stage pancreatic exocrine carcinoma. Methods. SEER data were evaluated for 17,234 patients diagnosed with Stage I/II pancreatic exocrine carcinoma. Multivariate regression models controlled for personal characteristics to determine whether insurance status was independently associated with overall survival and receipt of radiation/surgery. Results. Odds of receiving radiation were 1.50 and 1.75 times higher for insured patients compared to Medicaid and uninsured patients, respectively (p < 0.01). Insured patients had 1.68 and 1.57 times increased odds of receiving surgery compared to Medicaid and uninsured patients (p < 0.01). Risk of death was 1.33 times greater (p < 0.01) in Medicaid patients compared to insured patients; when further adjusted for treatment, the risk of death was attenuated but remained significant (HR = 1.16, p < 0.01). Risk of death was 1.16 times higher for uninsured patients compared to insured patients (p = 0.02); when further adjusted for treatment, the risk of death was no longer significant (HR = 1.01, p = 0.83). Conclusions. Uninsured and Medicaid-insured patients experience lower treatment rates compared to patients who have other insurances. The increased likelihood of treatment appears to explain the insured group's survival advantage.

目标。研究的目的是确定保险状况与早期胰腺外分泌癌患者的治疗接受和总生存期之间的关系。方法。对17234例I/II期胰腺外分泌癌患者的SEER数据进行了评估。多变量回归模型控制了个人特征,以确定保险状况是否与总体生存和接受放射/手术独立相关。结果。参保患者接受放疗的几率分别是参保患者和未参保患者的1.50倍和1.75倍(p < 0.01)。参保患者接受手术的几率是未参保患者的1.68倍和1.57倍(p < 0.01)。医疗补助患者的死亡风险是参保患者的1.33倍(p < 0.01);进一步调整治疗后,死亡风险有所降低,但仍有显著性差异(HR = 1.16, p < 0.01)。未参保患者的死亡风险是参保患者的1.16倍(p = 0.02);进一步调整治疗后,死亡风险不再显著(HR = 1.01, p = 0.83)。结论。与有其他保险的患者相比,没有保险和有医疗补助的患者的治疗率更低。治疗可能性的增加似乎解释了投保组的生存优势。
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引用次数: 12
Relationships between Global DNA Methylation in Circulating White Blood Cells and Breast Cancer Risk Factors. 循环白细胞整体DNA甲基化与乳腺癌危险因素的关系
IF 1.8 Q2 Medicine Pub Date : 2017-01-01 Epub Date: 2017-04-06 DOI: 10.1155/2017/2705860
Nayha Chopra-Tandon, Haotian Wu, Kathleen F Arcaro, Susan R Sturgeon

It is not yet clear whether white blood cell DNA global methylation is associated with breast cancer risk. In this review we examine the relationships between multiple breast cancer risk factors and three markers of global DNA methylation: LINE-1, 5-mdC, and Alu. A literature search was conducted using Pubmed up to April 1, 2016, using combinations of relevant outcomes such as "WBC methylation," "blood methylation," "blood LINE-1 methylation," and a comprehensive list of known and suspected breast cancer risk factors. Overall, the vast majority of reports in the literature have focused on LINE-1. There was reasonably consistent evidence across the studies examined that males have higher levels of LINE-1 methylation in WBC DNA than females. None of the other demographic, lifestyle, dietary, or health condition risk factors were consistently associated with LINE-1 DNA methylation across studies. With the possible exception of sex, there was also little evidence that the wide range of breast cancer risk factors we examined were associated with either of the other two global DNA methylation markers: 5-mdC and Alu. One possible implication of the observed lack of association between global WBC DNA methylation and known breast cancer risk factors is that the association between global WBC DNA methylation and breast cancer, if it exists, is due to a disease effect.

目前还不清楚白细胞DNA整体甲基化是否与乳腺癌风险有关。在这篇综述中,我们研究了多种乳腺癌危险因素与全球DNA甲基化的三个标记之间的关系:LINE-1, 5-mdC和Alu。截至2016年4月1日,使用Pubmed进行文献检索,结合相关结果,如“白细胞甲基化”、“血液甲基化”、“血液LINE-1甲基化”,以及已知和疑似乳腺癌危险因素的综合列表。总的来说,文献中的绝大多数报告都集中在LINE-1上。在所有研究中,有相当一致的证据表明,男性白细胞DNA中LINE-1甲基化水平高于女性。在所有研究中,没有其他人口统计学、生活方式、饮食或健康状况风险因素与LINE-1 DNA甲基化一致相关。除了性别之外,几乎没有证据表明我们所研究的乳腺癌风险因素与另外两个DNA甲基化标记(5-mdC和Alu)中的任何一个有关。观察到的整体白细胞DNA甲基化与已知乳腺癌危险因素之间缺乏关联的一个可能含义是,整体白细胞DNA甲基化与乳腺癌之间的关联,如果存在的话,是由于疾病效应。
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引用次数: 11
Prevalence of EGFR Mutations in Lung Cancer in Uruguayan Population. 乌拉圭人群肺癌中EGFR突变的患病率
IF 1.8 Q2 Medicine Pub Date : 2017-01-01 Epub Date: 2017-06-28 DOI: 10.1155/2017/6170290
Nora Berois, Diego Touya, Luis Ubillos, Bernardo Bertoni, Eduardo Osinaga, Mario Varangot

Background: Incorporation of molecular analysis of the epidermal growth factor receptor (EGFR) gene into routine clinical practice represents a milestone for personalized therapy of the non-small-cell lung cancer (NSCLC). However, the genetic testing of EGFR mutations has not yet become a routine clinical practice in developing countries. In view of different prevalence of such mutations among different ethnicities and geographic regions, as well as the limited existing data from Latin America, our aim was to study the frequency of major types of activating mutations of the EGFR gene in NSCLC patients from Uruguay.

Methods: We examined EGFR mutations in exons 18 through 21 in 289 NSCLC Uruguayan patients by PCR-direct sequencing.

Results: EGFR mutations were detected in 53 of the 289 (18.3%) patients, more frequently in women (23.4%) than in men (14.5%). The distribution by exon was similar to that generally reported in the literature.

Conclusions: This first epidemiological study of EGFR mutations in Uruguay reveals a wide spectrum of mutations and an overall prevalence of 18.3%. The background ethnic structure of the Uruguayan population could play an important role in explaining our findings.

背景:将表皮生长因子受体(EGFR)基因的分子分析纳入常规临床实践是非小细胞肺癌(NSCLC)个性化治疗的一个里程碑。然而,EGFR突变的基因检测尚未成为发展中国家的常规临床实践。鉴于这类突变在不同种族和地理区域的患病率不同,以及拉丁美洲现有数据有限,我们的目的是研究乌拉圭NSCLC患者中主要类型的EGFR基因激活突变的频率。方法:通过PCR-direct测序,我们检测了289例乌拉圭NSCLC患者18 - 21外显子的EGFR突变。结果:289例患者中有53例(18.3%)检测到EGFR突变,女性(23.4%)高于男性(14.5%)。外显子的分布与文献报道相似。结论:乌拉圭EGFR突变的首次流行病学研究揭示了突变的广谱性,总体患病率为18.3%。乌拉圭人口的背景种族结构可能在解释我们的研究结果方面发挥重要作用。
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引用次数: 8
The Role of Neighborhood Characteristics in Late Stage Melanoma Diagnosis among Hispanic Men in California, Texas, and Florida, 1996-2012. 1996-2012年加利福尼亚州、德克萨斯州和佛罗里达州西班牙裔男性晚期黑色素瘤诊断中邻里特征的作用
IF 1.8 Q2 Medicine Pub Date : 2017-01-01 Epub Date: 2017-06-18 DOI: 10.1155/2017/8418904
Valerie M Harvey, Clinton W Enos, Jarvis T Chen, Hadiza Galadima, Karl Eschbach

Background: Hispanics diagnosed with cutaneous melanoma are more likely to present at advanced stages but the reasons for this are unknown. We identify census tracts at high risk for late stage melanoma diagnosis (LSMD) and examine the contextual predictors of LSMD in California, Texas, and Florida.

Methods: We conducted a cross-sectional study using geocoded state cancer registry data. Using hierarchical multilevel logistic regression models we estimated ORs and 95% confidence intervals for the impact of socioeconomic, Hispanic ethnic concentration, index of dissimilarity, and health resource availability measures on LSMD.

Results: We identified 12,493 cases. In California, late stage cases were significantly more likely to reside within census tracts composed mostly of Hispanics and immigrants. In Texas, LSMD was associated with residence in areas of socioeconomic deprivation and a higher proportion of immigrants. In Florida, living in areas of low education attainment, high levels of poverty, and a high percentage of Hispanic residents was significantly associated with LSMD. Residential segregation did not independently affect LSMD.

Conclusion: The influence of contextual predictors on LSMD varied in magnitude and strength by state, highlighting both the cosegregation of social adversity and poverty and the complexity of their interactions.

背景:被诊断为皮肤黑色素瘤的西班牙裔更有可能出现在晚期,但原因尚不清楚。我们确定了晚期黑色素瘤诊断(LSMD)高风险的人口普查区,并检查了加州、德克萨斯州和佛罗里达州LSMD的背景预测因素。方法:我们使用地理编码的州癌症登记数据进行了横断面研究。使用分层多水平逻辑回归模型,我们估计了社会经济、西班牙裔民族集中、不相似指数和卫生资源可用性措施对LSMD影响的or和95%置信区间。结果:共发现12493例病例。在加州,晚期病例更有可能居住在主要由西班牙裔和移民组成的人口普查区。在德克萨斯州,LSMD与居住在社会经济贫困地区和移民比例较高有关。在佛罗里达州,生活在受教育程度低、贫困程度高、西班牙裔居民比例高的地区与LSMD显著相关。居住隔离并没有独立影响LSMD。结论:情境预测因素对LSMD的影响程度和强度因州而异,突出了社会逆境和贫困的共同隔离及其相互作用的复杂性。
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引用次数: 17
Patterns of Sociodemographic and Clinicopathologic Characteristics of Stages II and III Colorectal Cancer Patients by Age: Examining Potential Mechanisms of Young-Onset Disease. 结直肠癌II期和III期患者的社会人口学和临床病理特征模式:探讨年轻发病的潜在机制
IF 1.8 Q2 Medicine Pub Date : 2017-01-01 Epub Date: 2017-01-23 DOI: 10.1155/2017/4024580
Caitlin C Murphy, Hanna K Sanoff, Karyn B Stitzenberg, John A Baron, Jennifer L Lund, Robert S Sandler

Background and Aims. As a first step toward understanding the increasing incidence of colorectal cancer (CRC) in younger (age < 50) populations, we examined demographic, clinicopathologic, and socioeconomic characteristics and treatment receipt in a population-based sample of patients newly diagnosed with stages II and III CRC. Methods. Patients were sampled from the National Cancer Institute's Patterns of Care studies in 1990/91, 1995, 2000, 2005, and 2010 (n = 6, 862). Tumor characteristics and treatment data were obtained through medical record review and physician verification. We compared sociodemographic and clinicopathologic characteristics and treatment patterns of younger (age < 50) and older (age 50-69, age ≥ 70) CRC patients. Results. Younger patients were more likely to be black (13%) and Hispanic (15%) than patients aged 50-69 years (11% and 10%, resp.) and ≥70 years (7% each). A larger proportion of young white (41%) and Hispanic (33%) patients had rectal tumors, whereas tumors in the right colon were the most common in young black patients (39%). The majority of younger patients received chemotherapy and radiation therapy, although receipt of microsatellite instability testing was suboptimal (27%). Conclusion. Characteristics of patients diagnosed with young-onset CRC differ considerably by race/ethnicity, with a higher proportion of black and Hispanic patients diagnosed at the age of < 50 years.

背景和目的。作为了解年轻(年龄< 50岁)人群中结直肠癌(CRC)发病率增加的第一步,我们在以人群为基础的新诊断为II期和III期CRC的患者样本中检查了人口统计学、临床病理、社会经济特征和治疗接受情况。方法。患者样本来自1990/91年、1995年、2000年、2005年和2010年美国国家癌症研究所的护理模式研究(n = 6,862)。通过病历回顾和医师验证获得肿瘤特征和治疗数据。我们比较了年轻(年龄< 50岁)和老年(年龄50-69岁,年龄≥70岁)结直肠癌患者的社会人口学、临床病理特征和治疗模式。结果。与50-69岁(分别为11%和10%)和≥70岁(各为7%)的患者相比,年轻患者更有可能是黑人(13%)和西班牙裔(15%)。年轻白人(41%)和西班牙裔(33%)患者有直肠肿瘤的比例较大,而右结肠肿瘤在年轻黑人患者中最常见(39%)。大多数年轻患者接受了化疗和放疗,尽管接受微卫星不稳定性测试并不理想(27%)。结论。诊断为年轻发病的CRC患者的特征因种族/民族而有很大差异,黑人和西班牙裔患者诊断年龄< 50岁的比例较高。
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引用次数: 22
Endocrine Therapy Initiation among Older Women with Ductal Carcinoma In Situ. 老年导管原位癌妇女的内分泌治疗开始。
IF 1.8 Q3 ONCOLOGY Pub Date : 2017-01-01 Epub Date: 2017-09-13 DOI: 10.1155/2017/6091709
Chelsea Anderson, Aaron N Winn, Stacie B Dusetzina, Hazel B Nichols

Background: Although treatment of ductal carcinoma in situ (DCIS) is controversial, national guidelines recommend considering endocrine therapy for women with estrogen receptor- (ER-) positive DCIS or those undergoing breast conserving surgery (BCS) without radiation. We evaluated uptake and predictors of endocrine therapy use among older women with DCIS.

Methods: In the SEER-Medicare database, we identified women aged 65+ years diagnosed with DCIS during 2007-2011. We evaluated demographic, tumor, and treatment characteristics associated with endocrine therapy initiation.

Results: Among 2,945 women with DCIS, 41% initiated endocrine therapy (66% tamoxifen, 34% aromatase inhibitors). Initiation was more common among women with ER-positive than ER-negative DCIS (48% versus 16%; HR = 3.75, 95% CI: 2.91-4.83); 28% of women with unknown ER status initiated endocrine therapy. Initiation was less common after BCS alone compared to BCS with radiation (32% versus 50%; HR = 0.69, 95% CI: 0.59-0.80).

Conclusions: Less than half of older women with DCIS initiate endocrine therapy to prevent second breast cancers. Our findings suggest use was more common, but not exclusive, among women with ER-positive DCIS, but not among women who underwent BCS alone. Endocrine therapy should be targeted toward patients most likely to benefit from its use.

背景:尽管导管原位癌(DCIS)的治疗存在争议,但国家指南建议对雌激素受体(ER)阳性DCIS患者或接受保乳手术(BCS)的患者考虑内分泌治疗。我们评估了老年DCIS妇女内分泌治疗的使用情况和预测因素。方法:在SEER-Medicare数据库中,我们确定了2007-2011年诊断为DCIS的65岁以上女性。我们评估了与内分泌治疗开始相关的人口统计学、肿瘤和治疗特征。结果:在2945名患有DCIS的女性中,41%开始了内分泌治疗(66%为他莫昔芬,34%为芳香化酶抑制剂)。与er阴性DCIS患者相比,er阳性DCIS患者的初始化更常见(48%对16%;Hr = 3.75, 95% ci: 2.91 ~ 4.83);28%的不明ER状况的妇女开始了内分泌治疗。与BCS合并放疗相比,单独BCS后的起始率较低(32%对50%;Hr = 0.69, 95% ci: 0.59-0.80)。结论:只有不到一半的DCIS老年妇女开始进行内分泌治疗以预防第二次乳腺癌。我们的研究结果表明,在er阳性DCIS的女性中使用更常见,但不是唯一的,而在单独接受BCS的女性中则不是。内分泌治疗应该针对最有可能从中受益的患者。
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引用次数: 0
期刊
Journal of Cancer Epidemiology
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