Hartwig Ziegler

Individual and joint contribution of family history and Helicobacter pylori infection to the risk of gastric carcinoma

Helicobacter pylori infection and a positive family history of gastric carcinoma have been identified as risk factors for the disease. It is unclear, however, to what degree their impact on the risk of gastric carcinoma is independent, because H. pylori also clusters within families.

A Population-Based Study of the Impact of Specific Symptoms on Quality of Life in Women With Breast Cancer 1 Year After Diagnosis

Whereas the role of specific symptoms, such as pain and fatigue, for quality of life (QOL) is unquestioned, their relative importance for long‐lasting impairments in QOL in cancer patients has rarely been assessed quantitatively. The authors, therefore, aimed to identify symptoms most predictive of limitations to function and overall QOL in women with breast cancer after completion of primary therapy.

Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study

PurposeBreast-conserving therapy (BCT) was developed to improve quality of life (QOL) in early stage breast cancer patients. Except for differences in body image, literature comparing the psychosocial sequelae of BCT with mastectomy is ambiguous and shows a lack of substantial benefits. However, knowledge regarding long term effects of treatment on QOL in breast cancer is very limited as most of the pertinent studies have been performed in the early post-operative period. Therefore we compared QOL in women with breast cancer undergoing BCT versus women undergoing mastectomy over a 5-year period following primary surgery.MethodsQOL was assessed at 1, 3, and 5 years after diagnosis in a population based cohort of 315 women with early stage breast cancer (UICC stage I-II) from Saarland (Germany) using the EORTC QLQ-C30 questionnaire and the breast cancer specific module BR23.ResultsBreast-conserving therapy was performed in 226 women (72%). After control for potential confounding, women with BCT reported better physical and role functioning, were sexually more active and more satisfied with their body image already at 1 year after diagnosis (all P values < 0.05). Differences in overall QOL and social functioning were gradually increasing over time and became statistically significant only at 5 years.ConclusionsWhereas some, very specific benefits of BCT, such as a better body image, are already visible very timely after completion of therapy, benefits in broader measures such as psychosocial well-being and overall quality of life gradually increase over time and become fully apparent only in the long run.

Risk of gastric cancer among smokers infected with Helicobacter pylori

Infection with the gastric bacterium Helicobacter pylori (in particular infection with CagA‐positive strains) and smoking have been identified as risk factors for the development of gastric cancer. Both risk factors are typically acquired early in life and prevail over decades if not for life. We assessed the individual and joint impact of both risk factors on gastric cancer risk in a population‐based case‐control study from Germany including 71 patients with histologically verified gastric cancer and 363 patients with colorectal cancer who served as controls. Information on smoking and potential confounding factors was collected by standardized interviews. H. pylori infection was measured serologically by immunoglobulin G antibody titers against H. pylori. In addition, antibodies against the CagA antigen were determined by Western blot. Twenty‐seven percent of cases compared with 15% of controls were smokers, and 43% of cases compared with 23% of controls were infected with CagA‐positive H. pylori strains. After control for potential confounders, the relative risk of gastric cancer was 2.6 (95% CI 1.2‐5.7) for nonsmoking subjects with CagA‐positive H. pylori infections and 7.2 (95% CI 2.2–23.6) for smoking subjects with CagA‐positive H. pylori infections compared with subjects without these risk factors. The corresponding relative risks for noncardia gastric cancer were 6.1 ( 95% CI 2.3–16.5) and 16.6 (95% CI 4.3–64.2). We conclude that smoking subjects with CagA‐positive H. pylori infections have a strongly increased risk of gastric cancer and may be an important group for targeting efforts of prevention and early detection.

Prevalence and determinants of exocrine pancreatic insufficiency among older adults: Results of a population-based study

Objective The prevalence and main determinants of exocrine pancreatic insufficiency were investigated in a large population-based sample of older adults by measuring pancreatic elastase-1 in stool. Material and methods The study comprised 914 participants aged 50 to 75 years recruited by their general practitioner during a general health examination. All participants and their physicians were asked to fill out a standardized questionnaire which contained information on socio-demographic and lifestyle factors as well as medical history. Native stool was examined for pancreatic elastase-1 with a commercially available ELISA (ScheBo® Tech, Giessen, Germany). Results Overall, 524 women and 390 men aged 50 to 75 years (mean age 61.9 years) were included in the analysis. In total, 105 (11.5%) of the 914 subjects showed signs of exocrine pancreatic insufficiency (EPI) with ≤200 μg elastase-1/g stool, and 47 (5.1%) subjects showed signs of a severe exocrine pancreatic insufficiency (SEPI, <100 μg elastase-1/g stool). There was a clear increase in EPI with age. Patients taking angiotensin-converting enzyme (ACE) inhibitors had a lower prevalence than subjects without this medication; these associations persisted after adjustment for covariates. Conclusions Prevalence of EPI increases with age and seems to be tentatively higher in men than in women. However, smoking seems to be an independent risk factor for EPI and SEPI whereas ACE-inhibitor intake might be a protective factor. The latter finding may even point to new options in the treatment of chronic pancreatitis.

Cancer survival in Germany and the United States at the beginning of the 21st century: An up-to-date comparison by period analysis

Transatlantic cancer survival comparisons are scarce and involve mostly aggregate European data from the late 1980s. We compare the levels of cancer patient survival achieved in Germany and the United States (US) by the beginning of the 21st century, using data from the Cancer Registry of Saarland/Germany and the SEER Program of the US. Age‐adjusted 5‐ and 10‐year relative survival for 23 common forms of cancer derived by period analysis for the 2000–2002 period were calculated, with additional detailed age‐ and stage‐specific analyses for cancers with the highest incidence. Among the 23 cancer sites, 5 (10) year relative survival was significantly higher for 1 (2) and 8 (5) cancers in Germany and the US, respectively. In Germany, survival was significantly higher for patients with stomach cancer, whereas survival was higher in the US for patients with breast, cervical, prostate, colorectal and oral cavity cancer. Among the most common cancers, age‐specific survival differences were particularly pronounced for older patients with breast, colorectal and prostate cancer. Survival advantages of breast cancer patients in the US were mainly due to more favorable stage distributions. This comprehensive survival comparison between Germany and the US suggests that although survival was similar for the majority of the compared cancer sites, long‐term prognosis of patients continues to be better in the US for many of the most common forms of cancer. Among these, differences between patients with breast and prostate cancer are probably due to more intensive screening activities.

Socio-demographic factors, health behavior and late-stage diagnosis of breast cancer in Germany: A population-based study

Late-stage diagnosis of breast cancer is associated with poor survival. Identification of individuals at high risk of late-stage diagnosis could be an effective step to reduce breast cancer mortality. We examined the association of socio-demographic factors and health behavior with breast cancer stage in a population-based sample of 380 female breast cancer patients in Saarland, Germany. Overall, 182 women (47.9%) were diagnosed with late-stage (regional or distant) breast cancer. After control for potential confounding by multivariate logistic regression, an increased risk of late-stage diagnosis was observed for older age (OR = 1.8; 95% CI 1.0-3.2), foreign nationality (OR = 3.9; 95% CI 0.7-20.8), living in large households (OR = 1.7; 95% CI 1.0-2.9), non-participation in general health check-up (OR = 1.5; 95% CI 0.9-2.4) and low interest in health care (OR = 1.6; 95% CI 1.0-2.7). The proportion of late-stage cancer was clearly decreased when tumors were detected by screening (OR = 0.4; 95% CI 0.2-0.8). Certain socio-demographic factors and characteristics of health behavior seem to represent independent risk indicators of late-stage diagnosis.

Changes of cardiovascular risk factors and their implications in subsequent birth cohorts of older adults in Germany: a life course approach

Background To examine lifetime patterns of cardiovascular risk factors and their implications in subsequent birth cohorts of older adults in Germany, who experienced very different political and socioeconomic conditions at various phases of their lives. Design and methods Participants of the ESTHER study, a statewide cohort study conducted in Saarland, Germany, were categorized into four birth cohorts: 1925-1934, 1935-1939, 1940-1944, 1945-1952. At baseline, lifetime history of body weight, physical activity, smoking and drinking habits, and of physician-diagnosed diabetes mellitus were documented. The average BMI, the average number of hours of physical activity, prevalence of smoking and alcohol consumption between ages 20 and 50 years were assessed. The relative risks of a first diagnosis of diabetes mellitus before or at the age of 50 years by birth cohorts were assessed by multiple logistic regressions controlling for education and BMI at the age of 20. Results For both men and women, later birth cohorts had considerably worse lifestyle profiles. The frequency of diabetes mellitus up to the age of 50 years was much higher in the later than in the earlier cohorts. The increase was more pronounced among men than among women. Conclusion Women and men reaching old age in the forthcoming years have more unfavourable lifetime risk factor profiles than earlier birth cohorts. These patterns might have substantial implications for the future burden of chronic disease. Eur J Cardiovasc Prev Rehabil 14: 809-814

THE ROLE OF SOCIOECONOMIC FACTORS IN THE SURVIVAL OF PATIENTS WITH COLORECTAL CANCER IN SAARLAND/GERMANY

The role of socioeconomic factors in the survival of patients with colorectal cancer was assessed using data from the cancer registry of Saarland/Germany, and census information. Among 2627 patients with colorectal cancer diagnosed from 1974 to 1983, patients from communities in the lowest of three categories defined by socioeconomic factors showed significantly lower survival rates than patients from other communities. After adjustment for potential biological and other sociogeographic risk factors in multivariate analyses, relative hazard of death associated with low socioeconomic status (SES) compared with high SES was estimated to be 1.22 (95% CI: 1.01-1.47) for colon cancer and 1.32 (95% CI: 1.09-1.60) for rectum cancer. The results are in agreement with earlier studies from North America, Hawaii and Sweden and indicate that an attempt to improve health care services and acceptance and possibly other relevant general living conditions in socioeconomically less privileged communities may be a rewarding approach towards increasing survival of patients with colorectal cancer.

Clinical epidemiology of bilateral breast cancer

Background. The clinical epidemiology of bilateral breast cancer was assessed in a population‐based study from Saarland, Germany.