Curtis Mettlin

American Cancer Society guidelines for the early detection of cancer.

This issue of CA inaugurates a yearly report on American Cancer Society guidelines for early detection of cancer in asymptomatic individuals.

Aspirin use, cancer, and polyps of the large bowel

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.

Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons.

A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977–1978 (2355 patients) and 645 institutions in 1983–1984 (3457 patients). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer Staging (AJCSS) system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retro- peritoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977–1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.

The American Cancer Society National Prostate Cancer Detection Project. Findings on the detection of early prostate cancer in 2425 men.

The American Cancer Society National Prostate Cancer Detection Project (ACS‐NPCDP) is a multidisciplinary, multicenter effort to assess the feasibility of early prostate cancer detection by digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA) assay. By June 1990, 2425 men not previously suspected of having prostate cancer had been examined in ten participating clinical centers according to the project protocol. Three hundred ninety‐six men (16.3%) were recommended for biopsy on the basis of TRUS or DRE. An analysis of the results of 330 completed biopsies showed 52 cancers detected by DRE and/or TRUS. Forty‐four (84.6%) of the men with cancer had positive TRUS examination results compared with 33 (63.5%) with positive DRE. Five additional cancers were discovered as a result of elevated PSA levels. The overall detection rate was 2.4% and this rate varied by age. The detection rate in men 55 to 60 years of age was 1.3% and this rose to 3.3% in men older than 65 years of age. The estimated sensitivity was significantly greater for TRUS compared with DRE (77.2% versus 57.9%; P < 0.05). The estimated specificity of DRE was greater than that of TRUS (96.3% versus 89.4%; P < 0.01). The positive predictive value (PPV) for the tests varied as a function of patient and disease characteristics. The overall PPV was 28.0% for DRE and 15.2% for TRUS. The occurrence of elevated PSA levels significantly increased the PPV of both TRUS and DRE. The majority of cancers detected were at early stages. These preliminary data suggest the feasibility of using these techniques to promote cancer control, but additional data and follow‐up are needed to assess the significance of the results.

National patterns of prostate cancer treatment by radical prostatectomy: results of a survey by the American College of Surgeons Commission on Cancer.

To evaluate the patterns of use of radical prostatectomy for the treatment of prostate cancer in the United States, the American College of Surgeons Commission on Cancer in association with the American Cancer Society and American Urological Association surveyed 484 institutions concerning 2,122 patients treated in 1990. The results revealed that 93% of the patients were younger than 75 years when treated. Pretreatment prostate specific antigen level was greater than 4.0 ng./ml. in 85.4% of the patients. Surgical-pathological evaluation showed that 57.5% of the patients treated had American Joint Committee on Cancer pathological stages O, I and II corresponding to American Urological Association stages A1 to B2. Positive pathological findings, for example microscopic tumor extension or invasion, were associated with elevated prostate specific antigen levels at followup. The mortality rate associated with the operation was 0.7%. Impotence following treatment was observed in 56.6% of the patients who were potent preoperatively and complete incontinence was reported in 3.6% of the patients who were previously continent. The data may provide benchmarks by which further trends in prostate cancer treatment may be compared.

Global breast cancer mortality statistics.

Breast cancer mortality is declining in the United States, as well as in certain other industrialized areas—such as Canada, Austria, Germany, and the United Kingdom—possibly due to increased utilization of mammographic screening, early detection of disease, and availability of improved therapies. At least some of the decline has been attributed, however, to the higher fertility rates of the cohort of women born between 1924 and 1938 who bore children during the post‐World War II period.

Beta‐carotene and animal fats and their relationship to prostate cancer risk. A case—control study

A case—control study of 371 prostate cancer patients and comparable control subjects admitted to Roswell Park Memorial Institute (RPMI), Buffalo, New York, was conducted. Data were obtained from routine epidemiologic questionnaires administered to all patients on admission. An index of beta‐carotene intake was computed based on the vitamin A activity of 27 fruits and vegetables included in a food frequency checklist. A similar measure of fat intake from meats was computed based on nine meats included in the checklist. Intake frequencies of common and alcoholic beverages also were studied. A significant age‐adjusted and residence‐adjusted protective effect for high levels of beta‐carotene intake was observed (relative risk [RR], 0.60; 95% confidence interval [CI], 0.37 to 0.99). This effect was evident particularly among men 68 years of age and younger (RR, 0.30; 95% CI, 0.13 to 0.66), but not among subjects older than 68 years of age. A trend toward increased risk for fat intake was not significant. However, the reported usual consumption of high‐fat milk was associated with increased risk (RR, 1.92; 95% CI, 1.05 to 3.50). A greater reported frequency of whole milk intake was similarly associated with increased risk. Men who reported drinking three or more glasses of whole milk daily had an RR of 2.49 (95% CI, 1.27 to 4.87), compared with men who reported never drinking whole milk. When these findings are evaluated in the context of other recent studies, the weight of the evidence appears to favor the hypothesis that animal fat intake is related to increased risk of prostate cancer.

The National Cancer Data Base report on prostate carcinoma after the peak in incidence rates in the U. S.

Prostate carcinoma incidence has been declining since 1992 after a period of marked increase. Recent data from the National Cancer Data Base (NCDB) were examined to assess changes in prostate carcinoma patient characteristics and disease and treatment patterns coincidental to this decline. The NCDB is a program of the American College of Surgeons Commission on Cancer and the American Cancer Society that collects timely data from institutions representing every level of cancer care.

The National Cancer Data Base Report on Bladder Carcinoma

Previous Commission on Cancer Data from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1993) data relating to patients with bladder carcinoma are described here.

Diet and cancer of the esophagus

The reported dietary, alcohol consumption and smoking habits of 147 Roswell Park Memorial Institute white male patients diagnosed with cancer of the esophagus were compared with the reports of 264 white males of comparable ages with diagnoses other than cancer. Overall frequency of vegetable an fruit consumption was associated with lower risk; persons reporting fruit and/or vegetable consumption 31-40 times a month had significantly greater risk than those who reported consumption 81 times a month or more. Calculated indexes of vitamin A and vitamin C intake were similarly related to reduction in risk. Dose-response gradients were observed for frequency of vegetable and/or fruit consumption, as well as for vitamin A and C intake. The putative protective effect of vegetable and fruit intake remained evident after controlling for its possible association with smoking and drinking. Previously reported associations of smoking, alcohol use and social class, as measured by type of occupation, were replicated in these data. The findings of this investigation in instances of colon, lung, bladder, oral, and laryngeal cancers, and with evidence of tumor inhibition by vegetable properties in animals. Interpretation of the findings is limited by the difficulties of retrospective assessment of dietary intake and by possible confounding by other factors known to be related to esophageal cancer.