Guy R. Newell

Non-Hodgkin's lymphoma in 90 homosexual men: relation to generalized lymphadenopathy and the acquired immunodeficiency syndrome

We describe the histologic and clinical features of non-Hodgkins lymphoma diagnosed between January 1980 and December 1983 in 90 homosexual men from San Francisco, Los Angeles, Houston, and New York. The median age was 37 years, with an age distribution identical to that for cases of AIDS reported to the Centers for Disease Control. Sixty-two per cent of the patients had high-grade (aggressive) subtypes of lymphoma, 29 per cent had subtypes of intermediate grade, and 7 per cent had low-grade subtypes. Histologic subtypes and malignant cell phenotypes were consistent with a B-cell origin. All but two men had extranodal lymphoma: central-nervous-system, bone-marrow, bowel, and mucocutaneous sites were most commonly involved. Thirty-five of 66 evaluable men (53 per cent) had complete responses to combination chemotherapy or radiotherapy or both, and thus far, 19 (54 per cent) of them have had a relapse. Mortality and morbidity were closely related to prodromal manifestations; death or illness have occurred in 19 (91 per cent) of the 21 men who presented with AIDS, in 26 (79 per cent) of the 33 who presented with generalized lymphadenopathy, and in 5 (42 per cent) of the 12 who had no prodromal manifestations. Mortality rates analyzed according to histologic grade were higher than currently reported rates in other patient populations. Kaposis sarcoma or severe opportunistic infections characteristic of AIDS developed in 14 of 33 men (42 per cent) who presented with generalized lymphadenopathy and in 3 of 12 (33 per cent) without prodromal manifestations. We conclude that non-Hodgkins lymphoma in members of an AIDS risk group is a serious manifestation of AIDS and the AIDS-related complex.

Squamous cell carcinoma of the upper aerodigestive tract. A case comparison analysis

Although the etiologic importance of tobacco in risk of upper aerodigestive malignancies is unquestioned, quantification of subsite‐specific risks is less well delineated. Risk estimates from this case‐control study are derived from self‐administered comprehensive risk factor questionnaires distributed to newly registered patients at The University of Texas M.D. Anderson Hospital and Tumor Institute, Houston. Cases included 185 white patients with histologically confirmed squamous cell carcinoma of the upper aerodigestive tract. An equal number of age‐frequency and sex‐frequency matched patients was randomly selected from the same patient population excluding only patients with diagnoses of squamous cell carcinoma of any site. A statistically significant dose‐response relationship for three categories of cigarette pack‐years was evident for both males (odds ratios [OR] = 1.8, 4.0, and 7.5) and females (OR = 1.5, 9.0, and 12.0). Highest risks were documented for laryngeal cancer (OR = 15.1) and lingual cancer (OR = 14.5). There was interaction between alcohol use and smoking among men, but no independent effect of alcohol consumption among either gender. After 15 years of smoking abstinence, males no longer exhibited increased risk (OR = 1.0) whereas the risk for females after 15 years of cessation was 1.5. There were also significantly increased risks among men associated with snuff dipping, cigar, and pipe use (OR = 3.4, 2.8, and 1.8, respectively). The differences in the magnitude of the risk estimates and dose‐response curves by subsite and by sex suggest a variable susceptibility to carcinogenic action.

Risk factor analysis among men referred for possible acquired immune deficiency syndrome

Responses to a lifestyle questionnaire among 13 patients with Kaposis sarcoma and 18 with an opportunistic infection were compared with those of 29 symptom-free referred individuals. Odds ratios (OR) with 95% confidence limits were calculated as an estimate of risk. Significantly elevated odds ratios (P less than 0.05) were found for cigarette smoking (OR = 3.4), marijuana use (OR = 3.7), nitrite use (OR = 5.5), frequenting bathhouses (OR = 7.6), prior syphilis (OR = 3.4), and fist-rectal sexual practices (OR = 3.5). A response gradient for the risk estimates was found for marijuana use (OR = 2.7 for occasional, OR = 4.3 for frequent use); nitrites (OR = 4.0 for occasional; OR = 6.3 for frequent use); and prior syphilis (OR = 2.9 for one to two previous infections and 9.0 for three or more). We believe the evidence is now sufficient to recommend preventive practices which may reduce the male homosexuals risk for developing acquired immune deficiency syndrome, Kaposis sarcoma, and/or opportunistic infections. These include cessation of cigarette smoking, marijuana use, and nitrite inhalation; reduction in number of anonymous sexual partners to decrease risk of sexually transmitted diseases; and avoidance of fisting.

Risk factors for major salivary gland carcinoma. A case-comparison study

The authors conducted a case‐comparison chart‐review study on 498 patients with histologically confirmed salivary gland carcinoma and 487 randomly selected patients registered at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1960 through 1981. The study was undertaken to identify potential risk factors for salivary gland carcinoma. Univariate analysis of the data indicated a relationship with prior radiation therapy (odds ratio estimate of 6.17 with 95% confidence limits of 3.11–12.22) and with previous primary cancer (odds ratio estimate 4.81 with 95% confidence limits of 2.70–8.55). For agricultural occupations, the odds ratio was 1.62 with confidence limits of 1.05 to 2.49. The excess for previous primary cancer was largely due to previous skin cancer, especially in men, for whom the odds ratio was 13.7 (4.17–44.97). Multivariate analysis of these data, using the logit model, confirmed the association with both previous primary cancer and previous radiation. The rationale for a possible relationship between cutaneous neoplasms and salivary carcinoma is explained in embryologic and histogenetic terms.

Incidence and descriptive features of testicular cancer among United States whites, blacks, and hispanics, 1973–1982

This is a descriptive epidemiologic report based on over 3000 incident testicular cancer cases occurring among residents of the US and Puerto Rico, as reported to the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute for the years 1973 through 1982. White men had significantly higher incidence rates than their New Mexico Hispanic, black, and Puerto Rican Hispanic counterparts with weighted risk ratios of 1.36, 4.62, and 4.80, respectively. Ethnic differences in incidence were least evident at the extremes of age. Although the distribution of histologic subtypes did not differ across ethnic strata, morphologic expression was related to age at diagnosis. There was a predominance of right‐sided tumor involvement in each ethnic group in childhood (<15 years of age), but not in the oldest age categories or among tumors presenting in cryptorchid testes. Never married men appeared to be at greater risk of developing nonseminoma testicular cancer than their married counterparts. Analysis of ethnic secular trends, using data from comparable geographic areas, showed a consistent increase in incidence among young men for all three ethnic groups. The contrast between the rate differences and the homogeneity of descriptive parameters across ethnic strata suggest the impact of quantitative rather than qualitative differences in environmental etiology.

Epidemiologic comparison of cancer of the testis and Hodgkin's disease among young males

In 1970 the epidemiologic similarities between Hodgkins disease and multiple sclerosis were first described, suggesting that a common agent or agents might be involved in their etiology. The hypothesis proposed at that time was that the agents followed the paralytic polio model: widespread infection with an agent of low pathogenicity at an early age, resulting in acquired immunity in later life. Lack of early infection results in the disease appearing in adulthood, with severe repercussions. This article extends the paralytic polio model to include testicular carcinoma, since the epidemiologic similarities between it and Hodgkins disease are striking. Specifically, the authors compare age at clinical onset, histologic type, time trends, race, socioeconomic status, geographic variation, occupation, and familial aggregation. It is suggested that the possibility of common etiologies involved in the pathogenesis of these two cancers be tested further by epidemiologic, clinical, or laboratory studies.

Special Report on Laetrile: The NCI Laetrile Review: Results of the National Cancer Institute's Retrospective Laetrile Analysis

The National Cancer Institute, in response to widespread public interest, undertook a retrospective analysis of Laetrile treatment. Only cases thought to have shown objective benefit from Laetrile were solicited by mail request to 385,000 physicians and 70,000 other health professionals and by direct contact with pro-Laetrile groups. Although it is estimated that at least 70,000 Americans have used Laetrile, only 93 cases were submitted for evaluation. Twenty-six of these Laetrile cases had to be eliminated because of insufficient documentation, and an equal number of conventionally treated cases selected from the institutes files were added to the records to be analyzed. A panel of 12 oncologists, who had no knowledge of the actual treatments given, was then asked to evaluate the results of 160 courses of treatment (68 Laetrile, 68 chemotherapy, 24 no treatment) in the abstracted records from 93 patients. The panel judged six Laetrile courses to have produced a response (two complete and four partial). These results allow no definite conclusions supporting the anti-cancer activity of Laetrile. The National Cancer Institute will use the data in deciding if further study is needed.

Prognostic indicators in Hodgkin's disease.

A series of 270 patients with Hodgkins disease, diagnosed between July 1953 and July 1968, and classified according to the Lukes‐Butler histologic classification scheme, is used to illustrate two statistical procedures for evaluating the simultaneous effect of various prognostic factors. The results are presented as equations in which median years of survival depend jointly on histologic type, sex, stage of disease, and symptoms at diagnosis. The data included in this report are sufficient for illustrating the statistical methods, although a much larger series of Hodgkins disease patients would be required for carrying out an analysis of this type that would provide valid results for survival prediction.

Nutrition and diet.

During recent years there has been a growing awareness among both the oncologic and nutrition communities about an association between nutrition and cancer causation with the practical implication of manipulating nutrition as a means of preventing cancer. Epidemiologic correlations, prospective studies of selected populations, and dietary histories of cancer cases compared to suitable comparisons all point toward such associations. For some of the more common cancers in this country, it is thought that individuals can exert a certain amount of control over his or her own cancer risk through diet and lifestyle. As more is learned about mechanisms of mutagens and carcinogens, it may be routinely possible to inhibit, block, or reverse the cellular processes involved in carcinogenesis. It has been estimated that up to 35% of cancers may eventually be prevented by dietary modification. Until the final answers are found, it seems prudent to reduce total dietary fat intake and increase total fiber intake.

Viral etiology of testicular tumors.

Testicular carcinoma and Hodgkins disease are among the most frequent malignancies afflicting young men in the 15 to 39-year age group. These malignancies share other epidemiological characteristics as well, including multiple histological tumor types, higher rates of occurrence in white, urbanized populations and upper social classes, relative infrequency among black populations, low but definite familial occurrence and an early geographically acquired lifetime risk irrespective of later migration. Both diseases are increasing in this country. This epidemiological similarity suggests exposure to an infectious agent early in life. The Epstein-Barr virus is known to be oncogenic and neonatal exposure with early infection is believed to be associated with Burkitts lymphoma in African children. High titers of antibodies to the Epstein-Barr virus capsid antigen also have been reported in a series of studies comparing patients with Hodgkins disease and controls. Because testicular cancer is epidemiologically similar to Hodgkins disease and, therefore, might be expected to manifest similar Epstein-Barr virus findings, we performed a viral screen (Epstein-Barr virus, cytomegalovirus, and hepatitis A and B viruses) on blood samples from 56 consecutive patients with clinical stage I germ cell tumors of the testis who had received no active therapy after orchiectomy. Our results show a high incidence (80 per cent) of previous exposure to Epstein-Barr virus and support the hypothesis of a possible infectious origin for testicular carcinoma.