Two hundred and three patients, 148 males and 55 females, who during the last month before admission had experienced at least one reversible cerebral ischemic attack of less than 72 hours duration, were randomly assigned to treatment with either acetylsalicylic acid (ASA) 1000 mg daily (101 patients) or placebo (102 patients). The average follow-up period was 25 months. The two treatment groups were comparable with respect to age, sex, associated diseases, risk factors, number and duration of cerebral ischemic attacks. No statistically significant differences were found between the treatment groups as to the primary end point: stroke or death (ASA group 20.8%, placebo group 16.7%). Occurrence of transient ischemic attacks during the treatment period was not reduced by ASA treatment, whereas there was a trend suggesting fewer myocardial infarctions in the ASA group (5.9%) than in the placebo group (13.7%). The difference, however, was not statistically significant (p = 0.10). We were thus unable to demonstrate any favorable influence of ASA 1000 mg daily in patients with reversible ischemic attacks. This study does not, of course, prove that ASA treatment is ineffective in stroke prevention.
From October 1977 to November 1982 premenopausal and menopausal high-risk breast cancer patients were included in a randomized trial (DBCG 77B). The primary surgical treatment was total mastectomy with axillary dissection. In the trial, a total of 1,034 patients were enrolled and received postoperative radiotherapy (RT) and were further randomized to 1) no systemic treatment, 2) cyclophosphamide, or 3) cyclophosphamide + methotrexate + 5-fluorouracil. The chemotherapy was given for one year. With a median observation time of ten years, the survival was 45, 60 and 62%, respectively. Retrospectively, the survival benefit was observed to be most pronounced in the age group less than 40 years, in patients with tumour size less than or equal to 5 cm or with less than or equal to 3 positive lymph nodes. In high-risk premenopausal and menopausal patients adjuvant chemotherapy combined with RT thus resulted in a more than 25% relative reduction in mortality at ten years of observation compared with RT alone.
The role of antiestrogen treatment of postmenopausal breast cancer patients with high risk of recurrent disease is evaluated in a nationwide, prospective trial conducted by the Danish Breast Cancer Cooperative Group (DBCG). After total mastectomy and postoperative radiotherapy (RT), 840 patients were randomized to treatment with tamoxifen (RT + TAM) for one year, and 824 were randomized to no further therapy (RT). The recurrenceree survival (RFS) after ten years of lifeable analysis is 31% in the RT + TAM treated group, and 28% in the RT group (p = 0.01). Survival is 38% and 34% in the two treatment groups, respectively (p = 0.04). The data were further analyzed with respect to prognostic factors such as age, number of positive nodes, tumour size, and degree of anaplasia. Survival is prolonged in nearly all subgroups of patients treated with RT + TAM. However, the prolongation is only significant in patients with four or more positive nodes, with tumours of less than 5 centimeters or with tumours of anaplasia grade II. Estrogen (ER) and progesterone receptor (PgR) concentrations were measured in tumours from 309 and 219 patients, respectively. Only patients with ER and PgR values above 100 fmol/mg cytosol protein seemed to have a prolongation of survival. In conclusion, a modest survival benefit is achieved with one year of adjuvant tamoxifen treatment. Nevertheless, this is the first example of a systemic treatment approach being able to change the fatal course of breast cancer in postmenopausal patients. By means of endocrine therapy, and in the context of a new randomized trial, the DBCG will try to improve the survival in these patients even further.
Groups with assumed health-protective life-styles have been studied for several decades, in search of causes for cancer. We have analyzed cancer incidence, total mortality, and cause-specific mortality in Norwegian teetotalers to assess the possible health gains from an alcohol-abstaining life-style. A cohort of 5332 members of the International Organization of Good Templars was followed for 10 years from 1980. The cancer incidence and the cause-specific mortality of the cohort has been compared to that of the total Norwegian population. The standardized incidence ratio (SIR) for all cancer sites was 74 [95% confidence interval (CI), 64-80] for men and 72 (95% CI, 61-84) for women. For possible alcohol-associated cancers, such as cancer of the oral cavity, pharynx, esophagus, liver, and larynx, the SIR was 43 (95% CI, 17-88) for both sexes combined. For lung cancer the SIR was 57 (95% CI, 37-90) for men and 10 (95% CI, 0-57) for women. When all alcohol- and tobacco-associated cancers were excluded, the SIR for both sexes combined was 79 (95% CI, 69-87). The standardized mortality ratio for total mortality was 81 (95% CI, 65-74). This significant decrease in total mortality was caused by reduced risks for all major causes of death. The study indicates that members of the Norwegian chapter of the International Organization of Good Templars are a low-risk group not only regarding alcohol- and tobacco-associated cancers, but also regarding all other cancers.
In a study of breasts from 83 consecutive, unselected female autopsies, 23 women (28%) were found to have radial scars. The lesion was multicentric in 67% and bilateral in 43%. The frequency of radial scar was significantly increased among women with fibrocystic disease (43%) compared to women without this lesion (17%). No difference in the frequency of radial scar was registered between women with primary breast malignancy and women with either normal breasts or benign breast abnormalities. No radial scar demonstrated transition to invasive or in situ carcinoma. No evidence was found of any association between radial scar and breast carcinoma.
The role of antiestrogen treatment in high risk postmenopausal patients with primary breast cancer is currently evaluated in a nationwide, prospective randomized trial conducted by the Danish Breast Cancer Cooperative Group. The primary treatment is total mastectomy and radiotherapy. As of February 1, 1982, 720 women were randomized to treatment with tamoxifen (30 mg daily for 1 year) and 691 women were randomized to no further therapy. Life-table analysis after 36 months shows a difference in recurrence rates of 9% (p = 0.19) in favor of the tamoxifen-treated patients. The material has been analyzed with respect to established prognostic factors such as age, degree of anaplasia, tumor size, and number of positive nodes. The rates of recurrent disease are lower in all subsets of patients treated with tamoxifen, but are only statistically significant in patients 50-59 years of age or with 4 or more positive lymph nodes. Regardless of treatment, ER negative patients have a 23% higher recurrence rate than ER positive patients after 18 months of analysis (p = 0.0033); this represents an approximate doubling of risk, and is independent of age, degree of anaplasia, tumor size, or lymph node status. With regard to PgR status, there is 11% higher recurrence rate in the PgR negative than in the PgR positive patients (p = 0.097).
OBJECTIVES: The aim of the study was, on the basis of new information on nickel species and exposure levels, to generate a specific exposure matrix for epidemiologic analyses in a cohort of Norwegian nickel-refinery workers with a known excess of respiratory cancer. METHODS: A department-time-exposure matrix was constructed with average exposure to total nickel estimated as the arithmetic mean of personal measurements for periods between 1973 and 1994. From 1972 back to the start of production in 1910, exposure concentrations were estimated through retrograde calculation with multiplication factors developed on the basis of reported changes in the metallurgical process and work environment. The relative distribution of water-soluble nickel salts (sulfates and chlorides), metallic nickel, and particulates with limited solubility (sulfides and oxides) was mainly derived from speciation analyses conducted in the 1990s. RESULTS: The average concentration of nickel in the breathing zone was
Alcohol intake is causally associated with cancers of the larynx, oral cavity, pharynx, oesophagus and liver. In all five Nordic countries, alcohol consumption increased substantially between 1965 (6.5 litres per adult per year) and 1975 (10 litres), but remained at about 10 litres between 1975 and 1985. The daily consumption of men during the period was substantially higher than that of women, and that of both men and women was higher in Denmark than in the other Nordic countries. In about 2000, an annual total of almost 1,300 cancer cases (1,000 in men and 300 in women) would be avoided if alcohol drinking were eliminated. This corresponds to about 29% of all alcohol-related cancers, i.e. in the oesophagus (37%), oral cavity and pharynx (33%), larynx (29%) and liver (15%). About 2% of all cancers in men and 1% in women in the Nordic countries around the year 2000 will be caused by the drinking habits of the respective populations.