JoAnne Sylvester

Factors Predicting the Use of Breast-Conserving Therapy in Stage I and II Breast Carcinoma

PURPOSEnTo define patterns of care for the local therapy of stage I and II breast cancer and to identify factors used to select patients for breast-conserving therapy (BCT).nnnPATIENTS AND METHODSnA convenience sample of 16,643 patients with stage I and II breast cancer treated in 1994 was obtained from hospital-based tumor registries. Histologic variables were determined from original pathology reports.nnnRESULTSnBCT was performed in 42.6% of patients. Multivariate analysis demonstrated that living in the Northeast United States (odds ratio [OR], 2.48; 95% confidence interval [CI], 2.16 to 2.84), having a clinical T1 tumor (OR, 2.51; 95% CI, 2.27 to 2.78), and having a tumor without an extensive intraductal component (OR, 2.07; 95% CI, 1.81 to 2.37) were the strongest predictors of breast-conserving surgery. Radiation therapy was given to 86% of patients who had breast-conserving surgery. Age less than 70 years was the most significant predictor of receiving radiation (OR, 2.11; 95% CI, 1.77 to 2.25). Tumor variables did not correlate with the use of radiation, but favorable tumor characteristics were associated with the use of breast-conserving surgery.nnnCONCLUSIONnDespite strong evidence supporting the use of BCT, the majority of women continue to be treated with mastectomy. Predictors of the use of BCT do not correspond to those suggested in guidelines.

Survival discriminants for differentiated thyroid cancer

Since 1975, the American Cancer Society, Illinois Division, has published end results of major cancer sites drawn from patient data contributed voluntarily by hospital cancer registries throughout the state. The current study was undertaken, in part, to apprehend information regarding contested areas in the management of patients having differentiated (papillary/follicular) thyroid cancer. A total of 2,282 patients with either papillary or follicular carcinoma of the thyroid from 76 different Illinois hospitals and providing 10 years of follow-up information (life-table analysis) were retrospectively analyzed for demographic, disease, and treatment-related predictors of survival. Multivariate analysis using the Cox proportional hazards method was made for stage, age, race, sex, morphology, history of radiation exposure, presence of positive lymph nodes, initial surgical treatment, postoperative iodine 131 therapy, and replacement/suppressive thyroid hormone treatment. Statistically significant (p less than or equal to 0.05) predictors of favorable survival after thyroid cancer were low stage (I and II), young age (less than 50 years), white race, female sex, and the administration, postoperatively, of either thyroid hormone or radioactive iodine. Factors that had no influence on survival were lymph node status, choice of initial surgical treatment, and a history of prior irradiation. We suggest that where a prospective clinical trial is impracticable, a retrospective analysis of a large and detailed database, such as that available from cooperating hospital-based tumor registries, may yet provide useful insights to solutions of cancer management problems.

A mass screening program for colorectal cancer using chemical testing for occult blood in the stool

Following five promotional and educational programs on CBS‐TV news in Chicago, 54,101 Hemoccult® kits were requested by the public and distributed by seven cancer detection facilities. Only 14,074 individuals completed the test. Six hundred and seventeen or 4.38% were positive. Two hundred and fifteen test positive persons failed to respond to repeated notification. In 123 positives, diagnostic tests by the private physician were considered incomplete. In 33 positives, the private physician did no further testing at all. In 152 positives, no abnormality could be found, but work‐up was variable. One hundred and eighty‐seven had abnormalities other than cancer, including 40 with polyps. Twenty‐seven asymptomatic and two symptomatic cancers were found. Nearly two‐thirds had Dukes A or B lesions, while one‐third had Dukes C tumors.

Renal pelvic transitional cell carcinoma. The role of the kidney in tumor–node–metastasis staging

Renal pelvic carcinoma is a rare tumor. There are several staging systems currently in use based on a bladder cancer staging model. An analysis of the American Cancer Society, Illinois Division, experience with 611 cases of renal pelvic transitional cell carcinoma suggested that the kidney parenchyma may be a determinant in the anatomic spread of disease. A tumor–node–metastask system for renal pelvic (separate from ureteral) cancer is recommended.

Self‐reported dietary changes with respect to American cancer society nutrition guidelines (1982–1986)

A follow-up study was conducted by the Illinois Division of the American Cancer Society (ACS) in conjunction with the ongoing National Cancer Prevention Study II (CPSII) to determine whether self-report dietary changes are occurring in accordance with the ACS nutrition guidelines and to identify demographic subgroups that may be targeted for future prevention and education programs. A total of 42,300 CPSII respondents completed a 1986 questionnaire and were matched to 1982 baseline data. Dietary items were recorded as on the average, how many days per week do you eat the following foods? Individuals with known chronic conditions, body mass index outside a moderate range, and fewer than four completed food items were excluded. The remaining study population (n = 18,062) included men and women who were apparently healthy and primarily over the age of 50. The distribution of foods reported in 1982 and changes in foods consumed (1982-1986) among selected food groups varied modestly by sex, age, and educational level. Modest changes in the direction of decreasing intake of high-fat foods and increasing intake of high-fiber foods and cruciferous vegetables were reported. Dietary changes consistent with the ACS nutrition guidelines appear to have taken place in this population, particularly for the use of fried foods in males and intake of high-fiber foods and cruciferous vegetables in females.

A Grassroots Mammography Demonstration Project Targeted to Medically Underserved Rural and Urban Illinois Women of Diverse Races and Ethnicity

Abstract: Unique community and private‐sector linkages, initiated through American Cancer Society, Illinois Division, Inc. leadership, demonstrated that aggressive community interventions can increase mammography utilization in medically low socioeconomic status and ethnically and racially diverse women and thus help to save lives from breast cancer. Through volunteer involvement and breast cancer education, 2506 women were screened. Data showed that a medically and ethnically and racially diverse population in urban Chicago and rural Illinois had been reached.

Insurance Status as a Prognostic Factor for Stage and Survival of Testicular Cancer Patients in Illinois

ABSTRACT The American Cancer Society, Illinois division, collected clinical and insurance status data (staging, treatment, and survival) on 1142 testis cancer patients treated at 85 hospitals in the State of Illinois between January, 1982 and December, 1988. The clinical data are consistent with other large series whereas the insurance status data are unique. Patients were classified as underinsured (N=114) if they had Medicare, Medicaid or no method of payment. Other patients were classified as insured (N=897), or insurance status unknown (N=131). Among 500 non-seminoma patients a univariate prognostic factor analysis revealed that advanced stage, failure to use chemotherapy, under-insurance and symptom duration of greater than three months were adverse factors. Using the Cox proportional hazards method, advanced stage (P radiation therapy (P