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5-Alpha reductase inhibitor use and prostate cancer survival in the Finnish Prostate Cancer Screening Trial.

https://arctichealth.org/en/permalink/ahliterature275383
Source
Int J Cancer. 2016 Jun 15;138(12):2820-8
Publication Type
Article
Date
Jun-15-2016
Author
Teemu J Murtola
Elina K Karppa
Kimmo Taari
Kirsi Talala
Teuvo L J Tammela
Anssi Auvinen
Source
Int J Cancer. 2016 Jun 15;138(12):2820-8
Date
Jun-15-2016
Language
English
Publication Type
Article
Keywords
5-alpha Reductase Inhibitors - therapeutic use
Aged
Antineoplastic Agents - therapeutic use
Early Detection of Cancer
Finland - epidemiology
Humans
Kaplan-Meier Estimate
Male
Mass Screening
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prostatic Neoplasms - diagnosis - drug therapy - mortality
Abstract
Randomized clinical trials have shown that use of 5a-reductase inhibitors (5-ARIs) lowers overall prostate cancer (PCa) risk compared to placebo, while the proportion of Gleason 8-10 tumors is elevated. It is unknown whether this affects PCa-specific survival. We studied disease-specific survival by 5-ARI usage in a cohort of 6,537 prostate cancer cases diagnosed in the Finnish Prostate Cancer Screening Trial and linked to the national prescription database for information on medication use. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals for prostate cancer-specific deaths. For comparison, survival among alpha-blocker users was also evaluated. During the median follow-up of 7.5 years after diagnosis a total of 2,478 men died; 617 due to prostate cancer and 1,861 due to other causes. The risk of prostate cancer death did not differ between 5-ARI users and nonusers (multivariable adjusted HR 0.94, 95% CI 0.72-1.24 and HR 0.98, 95% CI 0.69-1.41 for usage before and after the diagnosis, respectively). Alpha-blocker usage both before and after diagnosis was associated with increased risk of prostate cancer death (HR 1.29, 95% CI 1.08-1.54 and HR 1.56, 95% CI 1.30-1.86, respectively). The risk increase vanished in long-term alpha-blocker usage. Use of 5-ARIs does not appear to affect prostate cancer mortality when used in management of benign prostatic hyperplasia. Increased risk associated with alpha-blocker usage should prompt further exploration on the prognostic role of lower urinary tract symptoms.
PubMed ID
26804670 View in PubMed
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5th Canadian Melanoma Conference: research frontiers.

https://arctichealth.org/en/permalink/ahliterature133428
Source
Expert Rev Anticancer Ther. 2011 Jun;11(6):845-8
Publication Type
Conference/Meeting Material
Date
Jun-2011
Author
Léon C van Kempen
Author Affiliation
Department of Pathology, McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine, Montréal, QC, H3T 1E2, Canada. leon.vankempen@mcgill.ca
Source
Expert Rev Anticancer Ther. 2011 Jun;11(6):845-8
Date
Jun-2011
Language
English
Publication Type
Conference/Meeting Material
Keywords
Antineoplastic Agents - pharmacology - therapeutic use
Canada
Disease Progression
Drug Delivery Systems
Early Detection of Cancer
Humans
Melanoma - pathology - therapy
Neoplasm Metastasis
Skin Neoplasms - pathology - therapy
Survival
Abstract
The prospects for the treatment of metastatic melanoma are improving. Whereas previous scientific meetings dedicated to the treatment of metastatic melanoma patients were overshadowed by our inability to improve overall survival or lengthen the time to progression, the results presented at the most recent meetings are hopeful. The 5th Canadian Melanoma Conference held on 24-27 February in Banff (AB, Canada) was nothing short of optimistic. This year's meeting was divided into three themes: basic science and pathology, dermatology and surgery, and immunology and systemic treatment. In addition, dermoscopy case studies were presented, and Hoffmann la Roche sponsored a symposium on the evaluation of treatment for advanced melanoma. It underscored the importance of early detection and patient stratification, based upon the molecular profile of the tumor, in order to optimize the response to targeted therapy.
PubMed ID
21707280 View in PubMed
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50 years of screening in the Nordic countries: quantifying the effects on cervical cancer incidence.

https://arctichealth.org/en/permalink/ahliterature257546
Source
Br J Cancer. 2014 Aug 26;111(5):965-9
Publication Type
Article
Date
Aug-26-2014
Author
S. Vaccarella
S. Franceschi
G. Engholm
S. Lönnberg
S. Khan
F. Bray
Author Affiliation
International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France.
Source
Br J Cancer. 2014 Aug 26;111(5):965-9
Date
Aug-26-2014
Language
English
Publication Type
Article
Keywords
Early Detection of Cancer - methods
Female
Finland - epidemiology
Humans
Incidence
Mass Screening - methods
Papillomavirus Infections - epidemiology
Scandinavia - epidemiology
Uterine Cervical Neoplasms - epidemiology - virology
Abstract
Nordic countries' data offer a unique possibility to evaluate the long-term benefit of cervical cancer screening in a context of increasing risk of human papillomavirus infection.
Ad hoc-refined age-period-cohort models were applied to the last 50-year incidence data from Denmark, Finland, Norway and Sweden to project expected cervical cancer cases in a no-screening scenario.
In the absence of screening, projected incidence rates for 2006-2010 in Nordic countries would have been between 3 and 5 times higher than observed rates. Over 60,000 cases or between 41 and 49% of the expected cases of cervical cancer may have been prevented by the introduction of screening in the late 1960s and early 1970s.
Our study suggests that screening programmes might have prevented a HPV-driven epidemic of cervical cancer in Nordic countries. According to extrapolations from cohort effects, cervical cancer incidence rates in the Nordic countries would have been otherwise comparable to the highest incidence rates currently detected in low-income countries.
PubMed ID
24992581 View in PubMed
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Abdominal symptoms and cancer in the abdomen: prospective cohort study in European primary care.

https://arctichealth.org/en/permalink/ahliterature303030
Source
Br J Gen Pract. 2018 05; 68(670):e301-e310
Publication Type
Journal Article
Date
05-2018
Author
Knut Holtedahl
Peter Hjertholm
Lars Borgquist
Gé A Donker
Frank Buntinx
David Weller
Tonje Braaten
Jörgen Månsson
Eva Lena Strandberg
Christine Campbell
Joke C Korevaar
Ranjan Parajuli
Author Affiliation
Department of Community Medicine, UiT The Arctic University of Norway, Norway.
Source
Br J Gen Pract. 2018 05; 68(670):e301-e310
Date
05-2018
Language
English
Publication Type
Journal Article
Keywords
Abdominal Neoplasms - diagnosis - epidemiology - pathology
Abdominal Pain - etiology - pathology
Adolescent
Adult
Aged
Aged, 80 and over
Belgium - epidemiology
Denmark - epidemiology
Early Detection of Cancer
Female
Gastrointestinal Hemorrhage - etiology - pathology
Hematuria - etiology - pathology
Humans
Male
Middle Aged
Netherlands - epidemiology
Norway - epidemiology
Primary Health Care
Prospective Studies
Referral and Consultation
Scotland - epidemiology
Sweden - epidemiology
Weight Loss
Young Adult
Abstract
Different abdominal symptoms may signal cancer, but their role is unclear.
To examine associations between abdominal symptoms and subsequent cancer diagnosed in the abdominal region.
Prospective cohort study comprising 493 GPs from surgeries in Norway, Denmark, Sweden, Scotland, Belgium, and the Netherlands.
Over a 10-day period, the GPs recorded consecutive consultations and noted: patients who presented with abdominal symptoms pre-specified on the registration form; additional data on non-specific symptoms; and features of the consultation. Eight months later, data on all cancer diagnoses among all study patients in the participating general practices were requested from the GPs.
Consultations with 61 802 patients were recorded and abdominal symptoms were documented in 6264 (10.1%) patients. Malignancy, both abdominal and non-abdominal, was subsequently diagnosed in 511 patients (0.8%). Among patients with a new cancer in the abdomen (n = 251), 175 (69.7%) were diagnosed within 180 days after consultation. In a multivariate model, the highest sex- and age-adjusted hazard ratio (HR) was for the single symptom of rectal bleeding (HR 19.1, 95% confidence interval = 8.7 to 41.7). Positive predictive values of >3% were found for macroscopic haematuria, rectal bleeding, and involuntary weight loss, with variations according to age and sex. The three symptoms relating to irregular bleeding had particularly high specificity in terms of colorectal, uterine, and bladder cancer.
A patient with undiagnosed cancer may present with symptoms or no symptoms. Irregular bleeding must always be explained. Abdominal pain occurs with all types of abdominal cancer and several symptoms may signal colorectal cancer. The findings are important as they influence how GPs think and act, and how they can contribute to an earlier diagnosis of cancer.
PubMed ID
29632003 View in PubMed
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Abdominal symptoms and cancer in the abdomen: prospective cohort study in European primary care.

https://arctichealth.org/en/permalink/ahliterature303215
Source
Br J Gen Pract. 2018 05; 68(670):e301-e310
Publication Type
Journal Article
Date
05-2018
Author
Knut Holtedahl
Peter Hjertholm
Lars Borgquist
Gé A Donker
Frank Buntinx
David Weller
Tonje Braaten
Jörgen Månsson
Eva Lena Strandberg
Christine Campbell
Joke C Korevaar
Ranjan Parajuli
Author Affiliation
Department of Community Medicine, UiT The Arctic University of Norway, Norway.
Source
Br J Gen Pract. 2018 05; 68(670):e301-e310
Date
05-2018
Language
English
Publication Type
Journal Article
Keywords
Abdominal Neoplasms - diagnosis - epidemiology - pathology
Abdominal Pain - etiology - pathology
Adolescent
Adult
Aged
Aged, 80 and over
Belgium - epidemiology
Denmark - epidemiology
Early Detection of Cancer
Female
Gastrointestinal Hemorrhage - etiology - pathology
Hematuria - etiology - pathology
Humans
Male
Middle Aged
Netherlands - epidemiology
Norway - epidemiology
Primary Health Care
Prospective Studies
Referral and Consultation
Scotland - epidemiology
Sweden - epidemiology
Weight Loss
Young Adult
Abstract
Different abdominal symptoms may signal cancer, but their role is unclear.
To examine associations between abdominal symptoms and subsequent cancer diagnosed in the abdominal region.
Prospective cohort study comprising 493 GPs from surgeries in Norway, Denmark, Sweden, Scotland, Belgium, and the Netherlands.
Over a 10-day period, the GPs recorded consecutive consultations and noted: patients who presented with abdominal symptoms pre-specified on the registration form; additional data on non-specific symptoms; and features of the consultation. Eight months later, data on all cancer diagnoses among all study patients in the participating general practices were requested from the GPs.
Consultations with 61 802 patients were recorded and abdominal symptoms were documented in 6264 (10.1%) patients. Malignancy, both abdominal and non-abdominal, was subsequently diagnosed in 511 patients (0.8%). Among patients with a new cancer in the abdomen (n = 251), 175 (69.7%) were diagnosed within 180 days after consultation. In a multivariate model, the highest sex- and age-adjusted hazard ratio (HR) was for the single symptom of rectal bleeding (HR 19.1, 95% confidence interval = 8.7 to 41.7). Positive predictive values of >3% were found for macroscopic haematuria, rectal bleeding, and involuntary weight loss, with variations according to age and sex. The three symptoms relating to irregular bleeding had particularly high specificity in terms of colorectal, uterine, and bladder cancer.
A patient with undiagnosed cancer may present with symptoms or no symptoms. Irregular bleeding must always be explained. Abdominal pain occurs with all types of abdominal cancer and several symptoms may signal colorectal cancer. The findings are important as they influence how GPs think and act, and how they can contribute to an earlier diagnosis of cancer.
PubMed ID
29632003 View in PubMed
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Access to breast cancer screening programs for women with disabilities.

https://arctichealth.org/en/permalink/ahliterature128355
Source
J Health Care Poor Underserved. 2012 Nov;23(4):1609-19
Publication Type
Article
Date
Nov-2012
Author
Renée Proulx
Céline Mercier
Fanny Lemétayer
Sylvie Jutras
Diane Major
Author Affiliation
CRDITED de Montréal, 75, rue de Port-Royal Est, bureau 110, Montréal, Québec, Canada H3L 3T1. renee.proulx@crditedmtl.ca
Source
J Health Care Poor Underserved. 2012 Nov;23(4):1609-19
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - diagnosis
Delphi Technique
Disabled persons - statistics & numerical data
Early Detection of Cancer - statistics & numerical data
Female
Health Services Accessibility - statistics & numerical data
Humans
Interviews as Topic
Mammography - statistics & numerical data
Middle Aged
Quebec
Abstract
The goal of this study was to identify measures to facilitate access to the Quebec Breast Cancer Screening Program for women with activity limitations, considering the barriers to screening uptake in that population.
The study was carried out in three stages. First, 124 semi-structured interviews were conducted in five regions of Quebec with five groups of key informants. The content analysis lead to the identification of 64 proposals, which were submitted to 31 experts through a two-round Delphi survey process. Finally, consultations were held with 11 resource people to determine which decision-making levels (local, regional, provincial) could play a key role in implementing the proposals.
A strong consensus (=80%) was achieved for 25 proposals seen as highly relevant and feasible.
The implementation of such proposals could substantially improve access to screening, given the prevalence of activity limitations in the age group targeted by the program.
PubMed ID
23698675 View in PubMed
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Access to medical care: how do women in Canada and the United States compare?

https://arctichealth.org/en/permalink/ahliterature115809
Source
Prev Med. 2013 May;56(5):345-7
Publication Type
Article
Date
May-2013
Author
Karen Buhr
Author Affiliation
Penn State Harrisburg, School of Public Affairs, Middletown, PA 17057, USA. kjb44@psu.edu
Source
Prev Med. 2013 May;56(5):345-7
Date
May-2013
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - prevention & control
Canada
Early Detection of Cancer - utilization
Female
Health Services Accessibility - statistics & numerical data
Humans
Insurance Coverage - statistics & numerical data
Mammography - utilization
Medically Uninsured - statistics & numerical data
Middle Aged
United States
Uterine Cervical Neoplasms - prevention & control
Vaginal Smears - utilization
Abstract
The purpose of this study is to determine if access to medical care and utilization of cancer screenings differs between women in the United States and Canada. This study examined this question by comparing women in Canada to women in the United States who have insurance coverage and those who do not.
This study used data from the 2002/03 Joint Canada United States Survey of Health and examined access to medical care and cancer screenings. A binary probit model was used to address several measures of access to medical care and cancer screening utilization.
This study finds five significant differences between insured American and Canadian women. Canadian women are better off in terms of ever having a mammogram, having a regular doctor, and having access to needed medicine, but fare worse in terms of having had a recent mammogram and having perceived unmet healthcare needs. With the exception of having recent mammograms, there is no statistical difference between uninsured and insured American women.
Although this study does not show that one group is strictly better off, it does show that there are significant differences between the two groups of women.
PubMed ID
23462478 View in PubMed
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Active surveillance: the Canadian experience.

https://arctichealth.org/en/permalink/ahliterature125792
Source
Curr Opin Urol. 2012 May;22(3):222-30
Publication Type
Article
Date
May-2012
Author
Laurence Klotz
Author Affiliation
Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Laurence.klotz@sunnybrook.ca
Source
Curr Opin Urol. 2012 May;22(3):222-30
Date
May-2012
Language
English
Publication Type
Article
Keywords
Aged
Biopsy
Canada
Disease Progression
Early Detection of Cancer
Humans
Male
Mass Screening - methods
Middle Aged
Neoplasm Grading
Patient Selection
Population Surveillance
Predictive value of tests
Prognosis
Prospective Studies
Prostatic Neoplasms - diagnosis - mortality - pathology - therapy
Risk assessment
Risk factors
Time Factors
Unnecessary Procedures
Watchful Waiting
Abstract
Active surveillance has evolved to become a standard of care for favorable-risk prostate cancer. This article is a summary of the rationale, method, and results of active surveillance beginning in 1995 with the first prospective trial of this approach.
This was a prospective, single arm cohort study. Patients were managed with an initial expectant approach. Definitive intervention was offered to those patients with a prostate specific antigen (PSA) doubling time of less than 3 years, Gleason score progression (to 4?+?3 or greater), or unequivocal clinical progression. Since November 1995, 450 patients have been managed with active surveillance. Median follow-up is 6.8 years (range 1-16 years). Overall survival is 78.6%. Ten-year prostate cancer actuarial survival is 97.2%. Five of 450 patients (1.1%) have died of prostate cancer. Thirty percent of patients have been reclassified as higher risk and offered definitive therapy. The commonest indication for treatment was a PSA doubling time less than 3 years (48%) or Gleason upgrading (26%). Of 117 patients treated radically, the PSA failure rate was 50%. This represents 13% of the total cohort. Most PSA failures occurred early; at 2 years, 44% of the treated patients had PSA failure. The hazard ratio for nonprostate cancer to prostate cancer mortality was 18.6 at 10 years.
We observed a very low rate of prostate cancer mortality in an intermediate time frame. Among the one-third of patients who were reclassified as higher risk and retreated, PSA failure was relatively common. However, other cause mortality accounted for almost all of the deaths. Further studies are warranted to improve the identification of patients who harbor more aggressive disease in spite of favorable clinical parameters at diagnosis.
PubMed ID
22453335 View in PubMed
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Adherence to breast and ovarian cancer screening recommendations for female relatives from the Ontario site of the Breast Cancer Family Registry.

https://arctichealth.org/en/permalink/ahliterature133576
Source
Eur J Cancer Prev. 2011 Nov;20(6):492-500
Publication Type
Article
Date
Nov-2011
Author
Michael A Campitelli
Anna M Chiarelli
Lucia Mirea
Lindsay Stewart
Gord Glendon
Paul Ritvo
Irene L Andrulis
Julia A Knight
Author Affiliation
Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada.
Source
Eur J Cancer Prev. 2011 Nov;20(6):492-500
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Breast Neoplasms - diagnosis - epidemiology - genetics
Cohort Studies
Cross-Sectional Studies
Early Detection of Cancer - standards
Female
Genetic Testing - standards
Humans
Mammography - standards
Middle Aged
Ontario - epidemiology
Ovarian Neoplasms - diagnosis - epidemiology - genetics
Patient compliance
Registries
Young Adult
Abstract
This study compares adherence to breast and ovarian cancer screening recommendations among a population cohort of women at familial risk of breast and/or ovarian cancer. This cross-sectional study included 1039 first-degree female relatives without breast cancer identified from the Ontario site of the Breast Cancer Family Registry. We compared breast and ovarian cancer screening behaviors, using a telephone-administered questionnaire among three groups of women defined by their familial risk (high, moderate, and low) of breast and/or ovarian cancer. Associations between screening behaviors and familial risk were assessed using multinomial regression models adjusted by familial clustering. Women, 40-49 years of age, at moderate or high familial risk were significantly more likely to have had a screening mammogram within the past 12 months [odds ratio (OR): 2.80; 95% confidence interval (CI): 1.40-5.58], and women of less than 50 years of age were more likely to have a clinical breast examination (OR: 1.84; 95% CI: 1.02-3.31) compared with women at low familial risk. Compared with women at low or moderate familial risk, women at high familial risk were significantly more likely to have ever had a genetic test for the BRCA 1/2 genes (OR: 2.67; 95% CI: 1.76-4.05). Although the overall level of adherence among high-risk women is suboptimal in the community, women at a higher familial risk are adhering more often to cancer screening recommendations than women at a lower familial risk.
Notes
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PubMed ID
21691207 View in PubMed
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Adherence to cancer screening guidelines across Canadian provinces: an observational study.

https://arctichealth.org/en/permalink/ahliterature142706
Source
BMC Cancer. 2010;10:304
Publication Type
Article
Date
2010
Author
Erin C Strumpf
Zhijin Chai
Srikanth Kadiyala
Author Affiliation
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 2T7, Canada. erin.strumpf@mcgill.ca
Source
BMC Cancer. 2010;10:304
Date
2010
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Breast Neoplasms - diagnosis - epidemiology - prevention & control
Canada - epidemiology
Colorectal Neoplasms - diagnosis - epidemiology - prevention & control
Cross-Sectional Studies
Early Detection of Cancer
Female
Guideline Adherence - standards
Humans
Male
Mass Screening
Middle Aged
Patient compliance
Practice Guidelines as Topic - standards
Prostatic Neoplasms - diagnosis - epidemiology - prevention & control
Abstract
Cancer screening guidelines reflect the costs and benefits of population-based screening based on evidence from clinical trials. While most of the existing literature on compliance with cancer screening guidelines only measures raw screening rates in the target age groups, we used a novel approach to estimate degree of guideline compliance across Canadian provinces for breast, colorectal and prostate cancer screening. Measuring compliance as the change in age-specific screening rates at the guideline-recommended initiation age (50), we generally found screening patterns across Canadian provinces that were not consistent with guideline compliance.
We calculated age-cancer-specific screening rates for ages 40-60 using the Canadian Community Health Survey (2003 and 2005), a cross-sectional, nationally representative survey of health status, health care utilization and health determinants in the Canadian population. We estimated the degree of compliance using logistic regression to measure the change in adjusted screening rates at the guideline-recommended initiation age for each province in the sample.
For breast cancer, after adjusting for age trends and other covariates, being above age 50 in Quebec increased the probability of being screened by 19 percentage points, from an average screening rate of 24% among 40-49 year olds. None of the other regions exhibited a statistically significant change in screening rates at age 50. Additional analyses indicated that these patterns reflect asymptomatic screening and that Quebec's breast cancer screening program enhanced the degree of guideline compliance in that province. Colorectal cancer screening practice was consistent with guidelines only in Saskatchewan, as screening rates increased at age 50 by 12 percentage points, from an average rate of 6% among 40-49 year olds. For prostate cancer, the regions examined here are not compliant with Canadian guidelines since screening rates were quite high, and there was not a discrete increase at any particular age.
Screening practice for breast, colorectal and prostate cancer was generally not consistent with Canadian clinical guidelines. Quebec (breast) and Saskatchewan (colorectal) were exceptions to this, and the impact of Quebec's breast cancer screening program suggests a role for policy in improving screening guideline compliance.
Notes
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PubMed ID
20565862 View in PubMed
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595 records – page 1 of 60.