John J. Fueger

Familial Patterns of Prostate Cancer: A Case-Control Analysis

Epidemiological data have not yet enabled physicians to look beyond age and race to identify men at increased risk for prostate cancer. We conducted a hospital-based case-control study of familial patterns of prostate cancer with self-reported data from a risk-factor questionnaire. There were 385 patients with histologically confirmed prostate cancer, and 385 race and age-matched (+/- 5 years) controls with other cancers. Family history, available for 378 patients and 383 controls, was positive for prostate cancer in 13.0% versus 5.7%, respectively. The difference was significant at p = 0.01. The over-all age-adjusted risk estimate for men with a first-degree relative with prostate cancer was significantly elevated (odds ratio of 2.41), as were the individual risk estimates for having a father or brother with prostate cancer (odds ratio of 2.24 and 2.66). Having a second-degree relative (grandfather or uncle) with prostate cancer also conferred elevated but not statistically significant risk. These data accord well with the few previously published case-control studies of familiarity of prostate cancer. On the basis of these findings, one should consider recommending participation in early detection programs for prostate cancer in a man whose father or brother has had the disease.

Lung carcinoma in former smokers

A reduction in the risk of lung carcinoma and a lower death rate among former smokers (FS) compared with current smokers (CS) have been documented in numerous U.S. and international studies. The main objective of our study was to compare the differences in demographic and clinical characteristics in groups stratified by smoking status and gender to evaluate the effect of smoking history and cessation on age at lung carcinoma diagnosis and on specific histologic type.

Cigarette smoking patterns in patients after treatment of upper aerodigestive tract cancers.

There is a paucity of data on variables predictive of successful smoking cessation in cancer patients. In this questionnaire-based study, we report the smoking status of 75 patients (46 men, 29 women) with head and neck cancer followed for a minimum of 30 months after definitive therapy. Seventy-one percent of the men and 61% of the women who were current smokers at diagnosis stopped smoking subsequent to diagnosis and treatment. Only 29% and 39%, respectively, continued to smoke, most at decreased intensity. Patients with laryngeal cancer were most likely to have stopped (83%). Conversely, patients with oral cavity cancer were most likely to be continuing smokers (66%). In addition, older age, college education, and lighter smoking habits were somewhat predictive of successful cessation. Fear of recurrent disease and physician advice were the questionnaire-listed incentives most often chosen as contributing to success in cessation. The role health professionals can play in counseling cancer patients to stop smoking is stressed.

Low incidence of familial breast cancer among Hispanic women

There is a paucity of data on familial patterns of breast cancer among minority populations. This study compared the frequency of cancer in 1,095 first-degree relatives of 50 White, 46 Black, and 49 Hispanic breast-cancer patients referred to The University of Texas M. D. Anderson Cancer Center (United States). Family histories of cancer were derived from a self-administered questionnaire on risk factors. Expected numbers of cancers were calculated from the Connecticut Tumor Registry for White and Black relatives and from the New Mexico Tumor Registry for Hispanic relatives. Family history of a first-degree relative with breast cancer was the most important risk factor for both Black and White patients. Significantly elevated standardized incidence ratios (SIR) for breast cancer were noted among White (SIR=4.5, 95 percent confidence interval [CI]=1.2–11.4) and Black (SIR=4.1, CI=1.1–10.4) relatives younger than age 45. Despite the small number of Black patients, the combined effect of family history of breast cancer and the relatives age at diagnosis (under 45 years) was associated with an SIR of 7.1 (CI=1.9–18.1). A deficit of cancer was noted in Hispanic women; only one patient reported having a first-degree relative with breast cancer. These findings, although based on small numbers, suggest that Hispanics have a lower rate of familial breast cancer than Whites and Blacks, and that they may possess protective factors that reduce their risk for breast cancer.

Leukemia and cigarette smoking.

A recent review of the epidemiologic evidence for an association between cigarette smoking and leukemia concluded that the relationship remained speculative and further epidemiologic evaluation was necessary.1 The presence of radioactive elements and benzene in cigarette smoke lends biological credence to implicating smoking as a risk factor for leukemia. However, prospective studies have yielded inconsistent findings, possibly because histologic subtypes could not be analyzed separately. 23 Retrospective studies have suggested a modest association with acute non-lymphocytic leukemia.4 6 We wish to report results from a casecontrol epidemiologic investigation of leukemia and smoking status. At The University of Texas M. D. Anderson Cancer Center, all newly registered adult patients are asked to complete a selfadministered, comprehensive, cancer riskfactor questionnaire that includes a detailed smoking hisory. Although the response rate averages only 45 percent, we have not demonstrated any significant differences in demographic characteristics between respondents and non-respondents. The reliability of the dichotomous smoking history variable (ever vs. never) has been reported by us previously as 98 percent. 7 The leukemia patients were 253 adults registered from November 1985 through December 1988. Control patients were randomly selected from all other cancer patients in the database after exclusion of those with smoking-related cancers. Controls were frequency matched to cases by age ( ± 1 year), race, and sex. Mean age was 50.7 years for the 144 male cases, 47.9 years for the 109 female cases. Ninety-four percent were white, three percent were Hispanic, and three percent were black. There were no significant differences between cases and controls with respect to educational level or annual income. Smoking data were available for all but 12 cases and 13 controls. Case and control distributions by smoking status are presented in Table 1. The prevalence rates of ever-smokers among our cases (60 percent for men, 39 percent for women) were lower than national data for 1985, derived from a probability sample of the non-institutionalized adult population (65 percent and 46 percent, respectively). 8 It is noteworthy that the prevalence rates among our control population (64 percent for men, 47 percent for women) accord very well with these national data. Casecontrol analyses revealed no association between cigarette smoking and leukemia for all types of leukemia combined, nor for any of the subtypes (See Table 1). These data accord with another hospitalbased case-control study, which used both cancer and non-cancer controls. 9 Furthermore, our risk estimates for chronic lymphocytic l eukemia and chronic myelogenous leukemia are identical to those reported by Brownson. 6 However, we were unable to confirm his 40 percent elevated risk for acute non-lymphocytic leukemia. It is not likely that any systematic bias reduced the odds ratio estimates to any great extent, although these risk estimates are derived from a single hospital population. It could be argued that non-response leads to under-reporting of smoking prevalence; nevertheless, this bias should have affected our cases and controls equally. Furthermore, the use of cancer controls also tends to mitigate recall bias. Leukemia occurrence and low smoking rates are both associated with higher socioeconomic standing. However, the lack of differences between cases and controls in educational level or annual income argues against social class as a confounding variable. Detailed evaluation of a suggested association between cigarette smoking and leukemia risk is more than an academic exercise. Even a small elevation in relative

Trends in prevalence of prognostic factors and survival in lung cancer patients from 1985 to 2004 at a tertiary care center

BACKGROUNDnAfter a prolonged period of increasing rates of lung cancer incidence and mortality for both men and women, incidence and mortality rates are decreasing in men and stabilizing in women. The goal of this study was to assess changes over 20 years in the prevalence of known risk factors for lung cancer and to elucidate possible predictors associated with lung cancer survival.nnnMETHODSnThe study included a total of 908 patients with primary lung cancer referred to The University of Texas M.D. Anderson Cancer Center over three study periods 1985-1989 (N=392), 1993-1997 (N=216), and 2000-2004 (N=300). Detailed questionnaires were used to collect information from the patients. Hazard ratios were estimated by fitting a Cox proportional hazards model. Using the Kaplan-Meier method, survival in months was calculated up to 2 years from the date of diagnosis to achieve comparability in the three groups.nnnRESULTSnWe observed a decrease in the proportion of patients who are current cigarette smokers and an increase in the proportion of patients who present with adenocarcinoma of the lung, are obese and patients who present with localized disease. We also found an increase in the number of patients who report a family history of lung cancer. The overall median survival duration has increased over the years from 12.0 months in 1985-1989 to 17.5 months in 2000-2004. Also, the probability of survival of patients who were alive at 2 years after diagnosis has also increased (26.5% in 1985-1989 to 40.8% in 2000-2004). Overall, women had a better median survival than men.nnnCONCLUSIONSnThe results show that the demographic, histologic, clinical, and outcome variables of patients with lung cancer have changed over the past 20 years. Most important, the survival of patients with lung cancer has improved.

Profiles of cigarette smoking among patients in a cancer center

Although cancer patients who continue to smoke are at high risk for subsequent malignancies, especially in tobacco-exposed tissues, they are rarely the target of intervention strategies. We present smoking behavior profiles on 2,531 adult patients registered at The University of Texas M.D. Anderson Cancer Center over a 15-month period. The data are derived from self-administered risk-factor questionnaires. Prevalence data are compared with 1985 data from the National Center for Health Statistics. Percentages of current smokers were similar for men (34.6%) and women (31.8%) and comparable with national survey data. Black men had the highest percentage of current smokers (41%), while Hispanic and black females had the lowest (26.1% and 26.7%, respectively). There were proportionately fewer quitters among women compared with men (19.1% v 37.8%) and among black men and women (20.5% and 11.5%, respectively) compared with whites and Hispanics. Fifty-five percent of male patients smoked over 25 cigarettes daily, compared with 33% of men in the national data. The comparable estimates for women were 31% and 21%. While there was a clear inverse association between educational attainment and smoking prevalence, those college-educated men who did smoke were heavier smokers than their less-educated counterparts. These data highlight the importance of tailoring educational programs to correspond with the specific smoking and demographic characteristics of the patient population.

Risk profiles of women with cervical neoplasia

Risk-factor profiles were compared in M.D. Anderson Cancer Center patients with various uterine cervix histologic diagnoses. Intraepithelial neoplasia (n = 171) and condyloma (n = 82) were associated with significantly lower patient age (mean 23.6 and 25.8 years, respectively). In addition, these two groups were lowest in annual income, age at beginning intercourse and at first pregnancy, and highest in percentages of black and Hispanic patients, number of sexual partners, and history of gonorrhea. Women with squamous carcinoma in situ (n = 47), who were about a decade older, exhibited a similar socioeconomic distribution and sexual history. All three groups also reported high prevalences of current smokers, were most likely to use oral contraceptives, and were least likely to use diaphragms or condoms. Patients with invasive squamous cell carcinoma (n = 77) had a mean age of 46.3 years, a large lowest-income constituency, and the highest mean number of pregnancies; they were least likely to have used oral contraceptives. Adenocarcinoma (n = 21) was epidemiologically distinct: a predominance of white woman characterized by high socioeconomic status, elevated body mass index, and non of the liberal sexual practices of the other groups. Primary and secondary prevention strategies must be tailored to the unique needs and socioeconomic status of the young at-risk populations.