Renée A. Harrison

Factors affecting survival following local, regional, or distant recurrence from localized melanoma

Background and Objectives: Approximately one third of all melanoma patients will experience disease recurrence. Factors that affect patient survival following local, regional, or distant first recurrences of localized melanoma are the subject of this investigation.

SOCIOECONOMIC CHARACTERISTICS AND MELANOMA INCIDENCE

PURPOSE This investigation examines the relationship between socioeconomic status (SES) and melanoma incidence in counties included in the Surveillance, Epidemiology, and End Results Registry (SEER) in the United States from 1973 to 1993. METHODS Cases included whites, aged at least 15 years, with a morphologic diagnosis of malignant melanoma, residing in one of 199 counties at the time of diagnosis. County level measures of SES including median household income, percentage of high school graduates, and percentage of families below poverty were abstracted from the 1950, 1960, 1970, 1980, and 1990 U.S. Census data. The relationship between SES factors and melanoma rates was examined by hierarchical Poisson regression. RESULTS The percentage of high school graduates was significantly and positively associated with the incidence of melanoma (relative risk (RR), 1.28; 95% confidence interval (CI), 1.21-1.35), after controlling for age at diagnosis, gender, time period, latitude, and percentage of Hispanics in the county. Percentage of families below poverty was significantly inversely associated with the incidence of melanoma (RR, 0.66; 95% CI, 0.55-0.78). When education and poverty were included in the same model, both the positive effects of education (RR, 1.23; 95% CI, 1.16-1.31) and the negative effects of poverty (RR, 0.85; 95% CI, 0.74-0.98) persisted. In contrast, median household income was not associated with melanoma incidence in a similar multivariable model (RR, 1.00; 95% CI, 0.99-1.00). CONCLUSION Whether the effect of education on incidence of melanoma reflects lifestyle behaviors that modify exposure to sunlight or some other factor remains unclear. Nonetheless, the findings of this study suggest that the determinant is primarily related to education, not income.

Associations of MHC genes with levels of caries-inducing organisms and caries severity in African-American women.

The aim of this investigation was to evaluate the relationship between MHC alleles at the HLA-DRB1, DQB1 and TNFa microsatellite loci and levels of oral bacteria that play a role in the etiology of dental caries, and the DMFS index in 186 AA primparous women. The average age of the cohort was 20.8+/-3.7 years. The median DMFS index was 9 (range 0-68). High levels of S. mutans were positively associated with DRB1*3 and DRB1*4 presence (p < or = 0.005). DRB1*8 was positively associated with higher levels of S. mutans as a percentage of total Streptococci (p = 0.04). DRB1*1 was positively associated with high levels L. casei (p = 0.04). DQB1 alleles were not observed associated with oral bacterial levels. TNFa allele 103 was negatively associated (p = 0.04), and TNFa 117 was positively associated (p = 0.007), with high levels of L. acidophilus. No significant associations were observed between any DRB1, DQB1 or TNFa allele and the DMFS index. These results support an hypothesis of an association between host HLA class II and TNFa genetic profile and colonization of S. mutans, L. casei, and L. acidophilus thought to be pathogens involved in the etiology of dental caries.

Clinical outcomes of localized melanoma of the foot: A case-control study

The controversy over whether melanoma of the foot has a poorer prognosis than melanoma of the leg remains unresolved. This investigation used a case-control design to address this issue. This design consisted of a survival analysis of 119 cases with localized melanoma of the foot and 238 controls with localized melanoma of the leg that were matched on prognostic factors including tumor thickness, ulceration, surgical treatment, gender, year of diagnosis, and age. There was a statistically significant difference between the survival rates of cases and controls. The 5-year survival rate for cases was 74.3% compared to 85.2% for controls. At 10 years, the survival rate was 63.6% for cases and 77.2% for controls. Cases experienced a higher percentage of distant recurrences than controls. These results imply that patients with melanoma of the foot have a poorer survival than patients with melanoma of the leg after controlling for prognostic factors.

Relationship Between Relative Risk of Developing Breast Cancer and Absolute Risk in a Population of Rural, Older African American Women

Abstract: Relative risks computed from known breast cancer risk factors can be used to quantitate a womans individual risk of developing breast cancer. However, among older women the absolute risk of developing breast cancer over a specified time interval may be more useful in risk‐benefit counseling. The objective of this investigation is to characterize the relationships between relative risks and absolute risks of breast cancer among a population of rural, older African American women. Among 224 African American women aged 50–91 years, relative risks were computed from historical information on age at menarche, number of previous biopsies, age at first birth, and number of first‐degree relatives with breast cancer. These estimates, combined with the womans current age, average remaining life expectancy, age‐specific mortality, and breast cancer incidence rates, were used to estimate lifetime probabilities of developing breast cancer. Most women in the cohort (72.8%) had weak relative risks of 1.01–1.5 and only 3.5% of the women had relative risks of greater than 3.0. The majority of the women (87.5%) had lifetime probabilities of developing breast cancer that were less than 5%. Although there is a marked increase in age‐specific breast cancer incidence with age, the probability of developing breast cancer in this population is low, primarily due to the low relative risks and the effects of competing mortality at older ages. Screening mammography should be directed toward women with high risks who are not receiving regular screening mammograms.

Cancer Prevention and Control

This chapter reviews the role of health education and health promotion in cancer prevention and control by examining the epidemiology of cancer and by reviewing a number of risk factors for cancer that can be impacted through the implementation of behavioral interventions. In addition, the psychosocial aspects of cancer are addressed and are linked to treatment issues in cancer prevention and control. Within each section of this chapter, we have attempted to review the relationship between behaviors and cancer at specific sites. This review is followed in most sections by an examination of the role of primary, secondary, and, when appropriate, tertiary prevention as they relate to these cancers.

Breast Cancer Detection Rates by Screening Mammography in Elderly Women

Abstract: Breast‐cancer risk factors, mammography history, and breast cancer detection rates were compared for women aged 50–64 years versus women 65 years and older. Mammographic screening examinations were performed on 936 women at least 65 years old and 1,926 women aged 50–64 years at a mobile van and an outpatient clinic of a tertiary referral university hospital. Breast‐cancer risk factors and frequency and timing of previous mammograms were assessed on all women. Of the 2,862 women screened, 520 (18.2%) were black. Women aged 65 and older were significantly more likely to be nulliparous, and over 30 years old at first pregnancy than women aged 50–64 years. The proportion of women who reported ever having a mammogram did not differ by age. For women who reported a previous mammogram, the intervals of the previous screening did not differ significantly by age group. Cancer detection rates were higher among women aged 65 and over at both locations. Among age and race groupings, the highest cancer detection rate occurred in black women over 65 years (19.7/1,000). Cancer detection rates were high enough to suggest that screening elderly women is efficacious. Because elderly black women may be less aware of breast‐cancer risk factors, relying on self‐referral for screening this population may be inappropriate. Barriers to mammographic screening among elderly women warrant further study.