Effect of Prevention Strategies on Survival and Quality-Adjusted Survival of Women With BRCA1/2 Mutations: An Updated Decision Analysis

2002 ◽  
Vol 20 (10) ◽  
pp. 2520-2529 ◽  
Author(s):  
Victor R. Grann ◽  
Judith S. Jacobson ◽  
Dustin Thomason ◽  
Dawn Hershman ◽  
Daniel F. Heitjan ◽  
...  
Keyword(s):  
Cancer Incidence ◽  
Preventive Measures ◽  
Prophylactic Mastectomy ◽  
Incidence Rates ◽  
Sensitivity Analyses ◽  
Prophylactic Surgery ◽  
Markov Modeling ◽  
Prophylactic Oophorectomy ◽  
Quality Adjustment

PURPOSE: This study updates findings regarding the effects of prophylactic surgery, chemoprevention, and surveillance on the survival and quality-adjusted survival of women who test positive for BRCA1/2 mutations. MATERIALS AND METHODS: Markov modeling of outcomes was performed in a simulated cohort of 30-year-old women who tested positive for BRCA1/2 mutations. The model incorporated breast and ovarian cancer incidence rates from the literature and mortality rates from the Surveillance, Epidemiology, and End Results Program. Quality adjustment of survival estimates were obtained from a survey of women aged 33 to 50 years. Sensitivity analyses were performed of varied assumptions regarding timing and effects of preventive measures on cancer incidence and adverse effects. RESULTS: A 30-year-old woman could prolong her survival beyond that associated with surveillance alone by use of preventive measures: 1.8 years with tamoxifen, 2.6 years with prophylactic oophorectomy, 4.6 years with both tamoxifen and prophylactic oophorectomy, 3.5 years with prophylactic mastectomy, and 4.9 years with both surgeries. She could prolong her quality-adjusted survival by 2.8 years with tamoxifen, 4.4 years with prophylactic oophorectomy, 6.3 years with tamoxifen and oophorectomy, and 2.6 years with mastectomy, or with both surgeries. The benefits of all of these strategies would decrease if they were initiated at later ages. CONCLUSION: Women who test positive for BRCA1/2 mutations may derive greater survival and quality adjusted survival benefits than previously reported from chemoprevention, prophylactic surgery, or a combination. Observational studies and clinical trials are needed to verify the results of this analysis of the long-term benefits of preventive strategies among BRCA1/2-positive women.

scholarly journals Ambient PM2.5 and Annual Lung Cancer Incidence: A Nationwide Study in 295 Chinese Counties

2020 ◽  
Vol 17 (5) ◽  
pp. 1481 ◽  
Author(s):  
Huagui Guo ◽  
Weifeng Li ◽  
Jiansheng Wu
Keyword(s):  
Lung Cancer ◽  
Cancer Incidence ◽  
Cancer Registries ◽  
Developed Countries ◽  
Incidence Rates ◽  
Lung Cancer Incidence ◽  
Lag Effects ◽  
Temperature And Precipitation ◽  
Males And Females

Most studies have examined PM2.5 effects on lung cancer mortalities, while few nationwide studies have been conducted in developing countries to estimate the effects of PM2.5 on lung cancer incidences. To fill this gap, this work aims to examine the effects of PM2.5 exposure on annual incidence rates of lung cancer for males and females in China. We performed a nationwide analysis in 295 counties (districts) from 2006 to 2014. Two regression models were employed to analyse data controlling for time, location and socioeconomic characteristics. We also examined whether the estimates of PM2.5 effects are sensitive to the adjustment of health and behaviour covariates, and the issue of the changing cancer registries each year. We further investigated the modification effects of region, temperature and precipitation. Generally, we found significantly positive associations between PM2.5 and incidence rates of lung cancer for males and females. If concurrent PM2.5 changes by 10 μg/m3, then the incidence rate relative to its baseline significantly changes by 4.20% (95% CI: 2.73%, 5.88%) and 2.48% (95% CI: 1.24%, 4.14%) for males and females, respectively. The effects of exposure to PM2.5 were still significant when further controlling for health and behaviour factors or using 5 year consecutive data from 91 counties. We found the evidence of long-term lag effects of PM2.5. We also found that temperature appeared to positively modify the effects of PM2.5 on the incidence rates of lung cancer for males. In conclusion, there were significantly adverse effects of PM2.5 on the incidence rates of lung cancer for both males and females in China. The estimated effect sizes might be considerably lower than those reported in developed countries. There were long-term lag effects of PM2.5 on lung cancer incidence in China.

scholarly journals Trends in Solid Tumor Incidence in Ukraine 30 Years After Chernobyl

2019 ◽  
pp. 1-10 ◽  
Author(s):  
Krystle M. Leung ◽  
Galyna Shabat ◽  
Pamela Lu ◽  
Adam C. Fields ◽  
Andrey Lukashenko ◽  
...  
Keyword(s):  
Cancer Incidence ◽  
Nuclear Power ◽  
Disease Burden ◽  
Incidence Rates ◽  
Chernobyl Nuclear Power Plant ◽  
Radioactive Fallout ◽  
Solid Organ ◽  
Solid Organ Malignancy ◽  
Ongoing Monitoring

PURPOSE There is limited knowledge of the long-term health effects of the Chernobyl nuclear power plant accident that occurred more than 30 years ago in Ukraine. This study describes trends in the incidence of solid organ malignancy in Ukraine and the five regions most affected by the radioactive fallout. METHODS The National Cancer Registry of Ukraine was queried for age-standardized incidence rates (ASIRs) of solid organ malignancy in Ukraine and the regions of Kyiv, Chernihiv, Zhytomyr, Rivne, and Volyn covering the period of 1999 to 2016. Joinpoint analysis was used to calculate the average annual percentage of change. RESULTS The highest burdens of cancer incidence in Ukraine were seen in the lung, stomach, breast, and prostate. We observed significant increases in the ASIRs of colon (average annual percentage of change, 1.5 [95% CI, 1.3 to 1.7]), rectal (0.9 [95% CI, 0.6 to 1.2]), kidney (2.3 [95% CI, 1.8 to 2.9]), thyroid (4.2 [95% CI, 3.1 to 5.3]), breast (1 [95% CI, 0.6 to 1.4]), cervical (0.7 [95% CI, 0.3 to 1.2]), and prostate (3.9 [95% CI, 3.6 to 4.2]) cancers, with decreases in stomach (−2.4 [95% CI, −2.5 to −2.3]) and lung (−1.8 [95% CI, −2.1 to −1.5]) cancers. ASIRs in the affected regions were similar to nationwide rates, with the exception of those for Kyiv. CONCLUSION The incidence rates of many solid organ malignancies in Ukraine are rising. However, the rates of solid organ malignancy in the five regions most affected by fallout did not substantially differ from national patterns, with the exception of those for Kyiv. Ongoing monitoring of cancer incidence in Ukraine is necessary to understand how best to decrease disease burden nationwide and to elucidate the causes of regional variations in ASIRs, such as access to diagnostics and environmental exposures.

Hormone Replacement Therapy and Life Expectancy After Prophylactic Oophorectomy in Women With BRCA1/2 Mutations: A Decision Analysis

2004 ◽  
Vol 22 (6) ◽  
pp. 1045-1054 ◽  
Author(s):  
Katrina Armstrong ◽  
J. Sanford Schwartz ◽  
Thomas Randall ◽  
Stephen C. Rubin ◽  
Barbara Weber
Keyword(s):  
Hormone Replacement Therapy ◽  
Life Expectancy ◽  
Decision Analysis ◽  
Replacement Therapy ◽  
Prophylactic Mastectomy ◽  
Hormone Replacement ◽  
Sensitivity Analyses ◽  
Decision Analytic Model ◽  
Prophylactic Oophorectomy ◽  
The Impact

Purpose The decision about prophylactic oophorectomy is difficult for many premenopausal women with BRCA1/2 mutations because of concerns and controversy about the use of hormone replacement therapy (HRT) after oophorectomy. Patients and Methods A Markov decision analytic model used the most current epidemiologic data to assess the expected outcomes of prophylactic oophorectomy with or without HRT (to age 50 years or for life) in cohorts of women with BRCA1/2 mutations. Sensitivity analyses were conducted to assess the impact of alternative assumptions about effects of HRT, effects of prophylactic oophorectomy, and risks of cancer associated with BRCA1/2 mutations. Results In our model, prophylactic oophorectomy lengthened life expectancy in women with BRCA1/2 mutations, irrespective of whether HRT was used after oophorectomy. This gain ranged from 3.34 to 4.65 years, depending on age at oophorectomy. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy (+0.17 to −0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life (−0.79 to −1.09 years). HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers undergoing both prophylactic mastectomy and oophorectomy. Conclusion On the basis of the results of this decision analysis, we recommend that women with BRCA1/2 mutations undergo prophylactic oophorectomy after completion of childbearing, decide about short-term HRT after oophorectomy based largely on quality-of-life issues rather than life expectancy, and, if using HRT, consider discontinuing treatment at the time of expected natural menopause, approximately age 50 years.

Decision Analysis of Prophylactic Surgery or Screening for BRCA1 Mutation Carriers: A More Prominent Role For Oophorectomy

2002 ◽  
Vol 20 (8) ◽  
pp. 2092-2100 ◽  
Author(s):  
Mariëlle S. van Roosmalen ◽  
Lia C.G. Verhoef ◽  
Peep F.M. Stalmeier ◽  
Nicoline Hoogerbrugge ◽  
Willem A.J. van Daal
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Risk Group ◽  
Prophylactic Mastectomy ◽  
Brca1 Mutation ◽  
Prophylactic Surgery ◽  
Breast And Ovarian Cancer ◽  
Prophylactic Oophorectomy ◽  
Mutation Carriers ◽  
Medium Risk

PURPOSE: BRCA1 mutation carriers have a high risk of developing breast and ovarian cancer. Carriers may opt for prophylactic surgery and screening. Recent data suggesting that prophylactic oophorectomy reduces breast cancer risk have been incorporated in a decision analysis. METHODS: A Markov model was developed to compare LE and QALE following four strategies: (1) prophylactic mastectomy and prophylactic oophorectomy (PMPO), (2) screening for breast cancer and prophylactic oophorectomy (BSPO), (3) prophylactic mastectomy and screening for ovarian cancer (PMOS), and (4) screening for breast and ovarian cancer (BSOS). The analysis was performed for a high (85% breast cancer, 63% ovarian cancer) and medium (56% breast cancer, 16% ovarian cancer) risk level. Utilities for the health states after prophylactic surgery were obtained from mutation carriers. Other model parameter values were obtained from the literature. Sensitivity analyses were performed. RESULTS: When compared with BSOS, the average gain in LE for 30-year-old carriers in the high (medium) risk group was 11.7 (6.6) years for PMPO, 9.5 (5.3) years for BSPO, and 4.9 (4.4) years for PMOS. For 30-year-old carriers, BSPO had a QALE advantage when PO was performed before age 40. In the medium-risk group, there was a stronger advantage for BSPO when QALE was considered. CONCLUSION: PMPO is the most effective strategy to prolong life. However, if patient preferences were taken into account, BSPO tends to be a better strategy in most women at medium risk or in young women at high risk when PO was performed before age 40.

scholarly journals Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands

Gut ◽  
2020 ◽  
pp. gutjnl-2020-322200 ◽  
Author(s):  
Tsung-Hsien Chiang ◽  
Wei-Jung Chang ◽  
Sam Li-Sheng Chen ◽  
Amy Ming-Fang Yen ◽  
Jean Ching-Yuan Fann ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Cancer Incidence ◽  
Control Period ◽  
Eradication Therapy ◽  
Incidence Rates ◽  
Long Term Effects ◽  
Incidence And Mortality ◽  
H Pylori

ObjectiveAlthough mass eradication of Helicobacter pylori has been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear.DesignMass eradication of H. pylori infection was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalent H. pylori infection. Test positives for the 13C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively.ResultsAfter six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates of H. pylori fell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI −14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate of H. pylori.ConclusionPopulation-based eradication of H. pylori has significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period.Trial registration numberNCT00155389

Clinical factors that affect breast cancer risk reduction decisions in high risk women tested for the BRCA1/2 genetic mutation

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1013-1013
Author(s):  
A. R. Uyei ◽  
K. R. Broglio ◽  
T. L. Solomon ◽  
K. J. Vogel ◽  
C. I. Amos ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Family History ◽  
Risk Reduction ◽  
Breast Biopsy ◽  
Prophylactic Mastectomy ◽  
Prophylactic Surgery ◽  
Clinical Factors ◽  
Prophylactic Oophorectomy ◽  
History Of

1013 Background: Women with an increased risk for breast cancer have many risk reduction options including: prophylactic mastectomy, prophylactic oophorectomy, chemoprevention, and screening. Women without breast cancer make such decisions in a purely preventive setting and factors that affect their decisions are unclear. Method: We performed an IRB approved retrospective review of the medical records on women who underwent BRCA testing. We evaluated the women without a history of breast cancer to assess clinical characteristics and their relation to decision making. The risk reduction categories analyzed were: prophylactic mastectomy, prophylactic oophorectomy, tamoxifen, increased surveillance with MRI, and standard screening (clinical breast exam and mammography). Patient characteristics were tabulated by clinical decision group and the chi-square test or Fisher’s exact test was used. Results: From 2001, 627 patients have undergone genetic testing. 202 of these women did not have a history of breast cancer among whom 58 were mutation carriers. Most patients chose standard screening (47%) or increased surveillance (38%). 4% chose tamoxifen, 7% chose prophylactic mastectomy, 3% chose both prophylactic mastectomy and oophorectomy, and 5% chose oophorectomy. The tamoxifen group was too small to do further analysis. Increased surveillance did not show any significant association with any of the clinical factors that we evaluated. The majority of women who chose standard screening had a personal history of ovarian cancer (p<0.0001) and had no family history of ovarian cancer (p=0.02). Prophylactic surgeries were significantly associated with positive BRCA status (p=0.01). Women with a family history of ovarian cancer tended to have prophylactic surgery (p=0.02). Women who had DCIS or a breast biopsy tended to have prophylactic mastectomies (p=0.0001 and p<0.001 respectively). Conclusion: In breast cancer free women, BRCA status, family history of ovarian cancer, DCIS, and breast biopsy were associated with prophylactic surgeries. Having ovarian cancer or no family history of ovarian cancer were associated with standard screening. We are performing a questionnaire study to determine the reasons behind these women’s choices. No significant financial relationships to disclose.

Reducing Effects of Anti-Epidemic (Quarantine) Measures during the COVID-19 Pandemic on the Incidence and Spread of Airborne Infectious Diseases (Based on the Example of Varicella)

2021 ◽  
pp. 55-62
Author(s):  
EP Lavrik ◽  
AG Kravchenko ◽  
GM Trukhina ◽  
АА Gerasimova ◽  
SA Vysotin ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Preventive Measures ◽  
Average Rate ◽  
Incidence Rates ◽  
Annual Data ◽  
Krasnodar Krai ◽  
Social Distancing ◽  
Restrictive Measures ◽  
Standard Techniques

Background. The coronavirus pandemic, also known as the COVID-19 pandemic, introduced significant changes in vital activities of the population and spread of airborne infectious diseases, the study of which enables ranking of preventive measures. The objective of our study was to assess the degree of influence of the lockdown and social distancing imposed in the Krasnodar Krai in 2020 due to the pandemic on the incidence of airborne communicable diseases based on the example of varicella. Materials and methods. We conducted a retrospective analysis of a 10-year incidence of varicella in the population of the Tuapse district, Krasnodar Krai using monthly and annual data on the incidence of infectious and parasitic diseases (Form No. 2) in the Tuapse district for 2011–2020 and the “Population Incidence” software, version 5, by applying standard techniques and methods of studying the epidemic process. Results. Stringent restrictive measures taken in the country in 2020 in the context of the COVID-19 pandemic caused a significant decrease (by 741 %) in the incidence of chickenpox among the population of the Tuapse district compared to the long-term average rate. In April – May and July – September 2020, varicella incidence rates were 30.98 and 7.75 per 100 thousand population or 7.4 and 18.8 times lower than the long-term average, respectively. The majority of chickenpox cases in the Tuapse district (as in the country as a whole) were pediatric – 94.02 % (RF – 94.3 %), with children aged 3 to 6 years making up 61 % of the total. Conclusion. The lockdown and social distancing imposed during the COVID-19 pandemic has a significant reducing effect on the incidence of airborne infectious diseases in the population in the absence of effective vaccination.

scholarly journals Utilisation of Prophylactic Mastectomy in 10 European Centres

1999 ◽  
Vol 15 (1-3) ◽  
pp. 148-151 ◽  
Author(s):  
D. G. R. Evans ◽  
E. Anderson ◽  
F. Lalloo ◽  
H. Vasen ◽  
M. Beckmann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Psychological Assessment ◽  
Prophylactic Mastectomy ◽  
Prophylactic Surgery ◽  
Breast Cancers ◽  
Screening Service ◽  
Long Term Follow Up ◽  
Extended Group

Increasingly women at high risk of breast cancer are opting for prophylactic surgery to reduce their risks. Data from 10 European centres that offer a risk counselling and screening service to women at risk show different approaches to the option of preventive surgery, although most centres adhere to a protocol including at least two risk counselling sessions and a psychological assessment. Thus far the combined centres have data on 174 women who have undergone prophylactic mastectomy with in excess of 400 women years of follow up. Operations were carried out on women with lifetime risks of 25–80%, with an average annual expected incidence rate of 1% per women. No breast cancers have occurred in this cohort. Long term follow up on an extended group of women will be necessary to truly address the risk of subsequent breast cancer and the psychological sequelae.

Sign in / Sign up

Export Citation Format

Share Document