Daniel S. Miller

Cervical cancer screening among low-income women: results of a national screening program, 1991-1995.

Objective To evaluate the results of cervical cytology screening in the National Breast and Cervical Cancer Early Detection Program and to compare the findings with results from other screening programs. Methods We analyzed data on 312,858 women aged 18 years and older who received one or more Papanicolaou smears, and follow-up if indicated, from October 1991 through June 1995 at screening sites across the United States providing comprehensive National Breast and Cervical Cancer Early Detection Program services. Results Of the women screened, more than half were 40 years or older; slightly less than half (44%) were of racial and ethnic minorities. During the first screening cycle, 3.8% of Papanicolaou tests were reported as abnormal (squamous intraepithelial lesion [SIL] or squamous cell cancer); proportions of abnormals decreased with increasing age. The age-adjusted rate of biopsy-confirmed cervical intraepithelial neoplasia (CIN) II or worse among women screened was 7.4 per 1000 Papanicolaou tests; rates of CIN were highest among young women, but cancer rates peaked among women in their 50s and 60s. The percentages of first screening cycle-Papanicolaou tests interpreted as high-grade SIL and squamous cell carcinoma associated with biopsyconfirmed CIN II or worse (the positive predictive value) were 56.0% for CIN II/III and 3.7% for invasive cancer. Of the 150 invasive cancers diagnosed, 54.0% were classified as local disease. Conclusion Observed results emphasize the duality of cervical neoplasia—CIN in younger women and invasive cancer in older women. This finding points to the importance of reaching both younger and older women for cervical cancer screening.

Public health perspectives on testing for colorectal cancer susceptibility genes

CONTEXT About 131,600 new cases of colorectal cancer will be diagnosed in the United States in 1998. About 27,900 men and 28,600 women will die from colorectal cancer in 1998. Mutations to the hMSH2 gene on chromosome 2p and to the hMLH1 gene on chromosome 3p have been identified as causes of colorectal cancer. These mismatch repair genes, which have recently been cloned, account for most cases of hereditary nonpolyposis colorectal cancer (HNPCC), one of the most common cancer susceptibility syndromes known. The carrier frequency of hMSH2 and hMLH1 gene mutations in the U.S. population is unknown. An adenomatous polyposis coli (APC) gene variant (I1307K allele), which was recently reported in 1 in 17 Ashkenazi Jewish persons, may double the risk for colorectal cancer in that population. CONCLUSIONS The use of genetic tests for susceptibility to cancer of the colon and other sites needs careful scrutiny. Several issues must be addressed before such tests can be recommended for population-based prevention programs. For example, the screening of population subgroups raises concern about potential discrimination and stigmatization. Before genetic tests for colorectal cancer are incorporated into future programs, the safety, effectiveness, and quality of these tests must be evaluated.

Breast and cervical carcinoma mortality among women in the Appalachian region of the U.S., 1976–1996 †

Previous studies have shown high cervical carcinoma mortality and increasing breast carcinoma mortality in the Appalachian region of the U.S. (which includes parts of 12 states and all of West Virginia). In the current study the authors report trends in breast and cervical carcinoma death rates among women in Appalachia for 1976–1996.

Patterns of inpatient surgeries for the top four cancers in the United States, National Hospital Discharge Survey, 1988-95.

AbstractBackground: At a time when the population is aging and medical practices are rapidly changing, ongoing surveillance of surgical treatments for cancer is valuable for health services planning. Methods: We used data from the National Hospital Discharge Survey for patients with discharge diagnoses of lung, prostate, female breast, and colorectal cancer during 1988–95 to estimate population-based rates and numbers of inpatient surgical procedures. Results: In 1988–91, rates of lobectomy for lung cancer were significantly higher in males than females. By 1994–95, the male/female differences had largely disappeared due to increasing trends among females and decreasing trends among males. During 1988–95, surgeries on the large intestine for colorectal cancer, including right hemicolectomy and sigmoidectomy, decreased significantly, as did abdominoperineal resections of the rectum. Anterior resections of the rectum increased significantly. Radical prostatectomies for prostate cancer increased from 34,000 in 1988–89 to 104,000 in 1992–93 and then decreased to 87,000 in 1994–95; rates followed a similar pattern. Finally, the number and rates of inpatient mastectomies for female breast cancer decreased over the study period (from 219,000 to 180,000 and from 78.8 to 61.5 per 100,000, respectively). Conclusion: These trends in inpatient surgeries for the major cancers in the US probably reflect changes in disease occurrence and modified treatment recommendations.

Cancer surveillance in the U.S.

Cancer‐related services are consuming ever‐increasing health resources; along with this trend, health care costs are rising. As health care planners, researchers, and policymakers formulate strategies to meet this challenge, they are looking to cancer registries and the health information system built around them as collectors of the most extensive information regarding cancer treatment in the U.S. Currently, there are multiple programs collecting and reporting data regarding cancer incidence, morbidity, mortality, and survival. This report profiles cancer surveillance efforts in the U.S. and describes the National Coordinating Council for Cancer Surveillance, which was organized in 1995 to facilitate a collaborative approach among the organizations involved. Cancer 1998;83:1282‐1291.

Clinical Value of 3-Dimensional Ultrasound in Gynecology: Clinical Value of 3D Ultrasound in Gynecology

This report provides examples of using 3‐dimensional ultrasound diagnostically in gynecology. The cost efficiency it provides and the wide range of applications it has support the routine use of this ultrasound technology in the practice of gynecology.

The nature of low anthropometry among low-income children screened in clinical settings

Abstract Low anthropometric status based on height and weight is commonly used as a sign of malnutrition. In developing countries low anthropometry is prevalent, due to poor dietary intake, infectious disease, or both. In the U.S., where the prevalence is low, the underlying reasons as to why children exhibit low anthropometry are not clear. This study documents the prevalence of low anthropometry and examines the characteristics of children with low anthropometric status. This is a descriptive study of two case series (inpatients and outpatients) of children with low anthropometry from Grady Memorial Hospital and its five satellite clinics, an urban hospital complex in Atlanta, GA. The subjects are predominantly low-income African American infants and children between the ages of 3 months and 10 years. Low anthropometry is defined as a