Polly Feigl

Treatment modality and quality differences for black and white breast cancer patients treated in community hospitals

This study assessed the relationship of race and patterns of care, defined by an expert NCI-appointed committee, for 7,781 patients with breast cancer treated in 107 hospitals in 45 communities between 1982 and 1985. After control for age and stage of disease, black patients had significantly different care from white patients for four of the ten patterns examined. They were less likely to have a progesterone receptor assay or to be referred for postmastectomy rehabilitation, two patterns deemed desirable for all patients. Black patients were also more likely to receive liver scans and radiation therapy in situations in which these procedures were labeled “less appropriate (as defined in the text).” Black patients differed significantly from whites on their health insurance, hospital, and physician characteristics; these factors were also significantly associated with the patterns of care. However, after controlling for these variables, the association between race and care persisted for three patterns. The patterns that showed racial differences were not the most clinically significant of the ten studied. Different treatment for black and white patients may help to explain differences in survival rates of black and white women with breast cancer.

An educational program to increase cervical and breast cancer screening in Hispanic women: a Southwest Oncology Group study.

We conducted a community-based pilot study to train Hispanic cancer survivors as promotoras (lay health educators) to encourage their social contacts to obtain breast and cervical cancer screening. Promotoras were recruited from a private oncologists practice at a Minority-Based Community Clinical Oncology Program (MBCCOP). Five Hispanic women were trained to serve as promotoras by attending a 12-week course. They shared cancer screening information with family and social contacts and encouraged them to obtain Papanicolaou smears and/or mammograms. Study endpoints included the number of women recruited and trained to serve as promotoras, the number of contacts made per promotora, and the number of contacts who were screened; data were based on contact logs maintained for 1 year. Screening examinations were documented by a postcard returned by the contact or by review of community health clinic records. Five promotoras contacted 141 (range = 24-49 per promotora) women to share cancer screening information. Fifty Hispanic women obtained screening after contact with a promotora. Twenty-nine underwent mammography (ages 25-58) and 43 received a Papanicolaou smear (ages 23-62). Hispanic female cancer survivors can be trained as promotoras. Screening information conveyed by a promotora can successfully prompt Hispanic women to obtain mammography and Papanicolaou smears.

Histocompatibility antigens in childhood-onset arthritis

One hundred and twelve well-studied patients with a prior diagnosis of juvenile rheumatoid arthritis were differentiated into seven clinically distinct subgroups, including a group in whom recognizable ankylosing spondylitis had developed by time of follow-up. An apparent increased prevalence of HLA-B27 in the entire series (26%) was clearly related to its increased prevalence in only two subgroups: patients whose disease had progressed to overt ankylosing spondylitis (five of five patients) and boys with pauciarticular arthritis whose disease would be consistent with early ankylosing spondylitis (11 of 18 patients). There were no significant associations of B27 with systemic onset JRA, polyarticular JRA, pauciarticular JRA in girls, or JRA with chronic iridocyclitis. The only other significant alterations found were increased prevalences of HLA-A2 and HLA-BW15 in patients with polyarticular disease without identifiable rheumatoid factor. This study emphasizes that the clinical disorders included under the category of juvenile rheumatoid arthritis represent more than a single disease and that this heterogeneity must be considered in interpreting studies such as those of histocompatibility typing.

Studying patterns of cancer care: how useful is the medical record?

Records of hospital inpatients were abstracted for 5,000 newly diagnosed cancer patients admitted in 1982-83 to 17 Comprehensive Cancer Centers and 17 Community Hospital Oncology Programs. Generally available data items (silent record rate less than 5 per cent for the typical institution) included: age, race, sex, dates of hospitalization, zip code of residence, pathological stage, dates of biopsy and surgery, numbers of nodes examined and positive, certain diagnostic procedures, and some radiotherapy descriptors. For other data items, there was enormous variability in completeness and high institution-to-institution variation. Record completeness did not differ consistently between comprehensive and community cancer centers. We conclude that the hospital patient record is useful for tracking the frequency of surgical and related events. However, studies of diagnostic and therapeutic procedures should not rely solely on the hospital medical record due to the high rates of silent records.

Cancer Chemoprevention with Vitamin A and Beta-Carotene in Populations at High-Risk for Lung Cancer

Vitamin A, beta-carotene, and synthetic retinoids have attracted wide interest as premising chemopreventive agents, based on work in rodents and in cultured cells and organs, and low dietary intake or low serum levels of vitamin A or beta-carotene have been associated with high risk for lung cancer (1–4). Even if the data were stronger, observational epidemiological studies cannot establish whether or not changing the vitamin A status of specific individuals or groups of individuals would alter their subsequent cancer risk. The hypothesis that increasing retinoid intake in humans would reduce the risk of lung cancer must be tested in humans. For both practical and ethical reasons, such studies should be undertaken initially among those at highest risk.

Chemoprevention of Lung Cancer with Retinol/Beta-Carotene

Lung cancer is a major health problem in the USA. It is estimated that in 1982, greater than 110,000 deaths were directly attributable to lung cancer.1 In addition to being the most common cause of cancer death in man (and in 1985, women also), lung cancer is unique in that the primary causative agent has been identified. Epidemiologic studies have clearly shown that cigarette smoking is a major etiologic factor in the development of pulmonary neoplasia.2,3,4 Although the public is well aware of this relationship, there has been little success in primary prevention. In general, anti-smoking campaigns are met with apathy and tobacco abuse continues. Because the primary prevention of lung cancer has not yet been possible, alternative methods of prevention are needed for those who are unable or unwilling to give up smoking. The availability of a “chemoprevention drug” for this population would be of significant public health interest.