Women who have had a first-degree relative diagnosed with breast cancer (ie, a positive family history) have a rate of breast cancer that is approximately twice that of all women their age, but it is unclear how they should perceive this risk at different ages or if they should be considered at higher risk for the remainder of their lifetime.
We used Swedish population–based data to assess the risk of breast cancer in 23654 sisters of women diagnosed with breast cancer and in 1 732 775 sisters of unaffected women from 1958 through 2001. Poisson models were used to express the rate of breast cancer as a function of current age, whether a woman had an affected sister, time since the first diagnosis in the family, and family size (number of sisters). The effect of the age of the index case (the first sister diagnosed in the family) at diagnosis and whether her "at-risk" sisters had achieved this age were examined in stratified analyses. Incidence rate ratios of breast cancer in exposed compared with unexposed sisters were calculated with 95% confidence intervals. All estimates were adjusted for calendar time.
Sisters of breast cancer patients had higher breast cancer incidence than unexposed sisters at all ages. The association of exposure (ie, a diagnosis of breast cancer in a sister) with the risk of breast cancer was most pronounced in young women (age 20–39; incidence rate ratio = 6.64, 95% confidence interval = 4.66 to 9.48), and the relative risk decreased to approximately 2 in women older than 50 years. The risk associated with having a sister diagnosed with breast cancer was not modified substantially by the age of the index case at diagnosis (≤45 years vs >45 years). The risk was similar for women who were approaching the age at which the first sister was diagnosed in their family and those who had already attained it. The incidence rate ratio of breast cancer in exposed sisters compared with unexposed sisters was constant over time for all age categories of at-risk women.
Women who have a sister diagnosed with breast cancer have an increased risk of breast cancer throughout much of their lifetimes.
Black patients with rectal cancer are considerably less likely than white patients to receive adjuvant therapy. We examined the hypothesis that the lower treatment rate for blacks is due to underreferral to medical and radiation oncologists.
We used 1992–1999 Surveillance, Epidemiology, and End Results–Medicare data to identify elderly (≥66 years of age) patients who had been hospitalized for resection of stage II or III rectal cancer (n = 2716). We used 2 tests to examine associations between race and 1) consultation with an oncologist and 2) receipt of adjuvant therapy. We then used logistic regression to analyze the influence of sociodemographic and clinical characteristics (age at diagnosis, sex, marital status, median income and education in area of residence, comorbidity, and cancer stage) on black–white differences in the receipt of adjuvant therapy. All statistical tests were two-sided.
There was no statistically significant difference between the 134 black patients and the 2582 white patients in the frequency of consultation with a medical oncologist (73.1% for blacks vs 74.9% for whites, difference = 1.8%, 95% confidence interval [CI] = >5.9% to 9.5%, P = .64) or radiation oncologist (56.7% vs 64.8%, difference = 8.1%, 95% CI = >0.5% to 16.7%, P = .06), but blacks were less likely than whites to consult with both a medical oncologist and a radiation oncologist (49.2% vs 58.8%, difference = 9.6%, 95% CI = 0.9% to 18.2%, P = .03). Among patients who saw an oncologist, black patients were less likely than white patients to receive chemotherapy (54.1% vs 70.2%, difference = 16.1%, 95% CI = 6.0% to 26.2%, P = .006), radiation therapy (73.7% vs 83.4%, difference = 9.7%, 95% CI = 0.4% to 19.8%, P = .06), or both (60.6% vs 76.9%, difference = 16.3%, 95% CI = 4.3% to 28.3%, P = .008). Patient and provider characteristics had minimal influence on the racial disparity in the use of adjuvant therapy.
Racial differences in oncologist consultation rates do not explain disparities in the use of adjuvant treatment for rectal cancer. A better understanding of patient preferences, patient–provider interactions, and potential influences on provider decision making is necessary to develop strategies to increase the use of adjuvant treatment for rectal cancer among black patients.
Physical activity has been consistently associated with lower risk of postmenopausal breast cancer, but its relationship with premenopausal breast cancer is unclear. We investigated whether physical activity is associated with reduced incidence of premenopausal breast cancer, and, if so, what age period and intensity of activity are critical.
A total of 64 777 premenopausal women in the Nurses’ Health Study II reported, starting on the 1997 questionnaire, their leisure-time physical activity from age 12 to current age. Cox regression models were used to examine the relationship between physical activity, categorized by age period (adolescence, adulthood, and lifetime) and intensity (strenuous, moderate, walking, and total), and risk of invasive premenopausal breast cancer.
During 6 years of follow-up, 550 premenopausal women developed breast cancer. The strongest associations were for total leisure-time activity during participants’ lifetimes rather than for any one intensity or age period. Active women engaging in 39 or more metabolic equivalent hours per week (MET-h/wk) of total activity on average during their lifetime had a 23% lower risk of premenopausal breast cancer (relative risk = 0.77; 95% confidence interval = 0.64 to 0.93) than women reporting less activity. This level of total activity is equivalent to 3.25 h/wk of running or 13 h/wk of walking. The age-adjusted incidence rates of breast cancer for the highest (≥54 MET-h/wk) and lowest (<21 MET-h/wk) total lifetime physical activity categories were 136 and 194 per 100 000 person-years, respectively. High levels of physical activity during ages 12–22 years contributed most strongly to the association.
Leisure-time physical activity was associated with a reduced risk for premenopausal breast cancer in this cohort. Premenopausal women regularly engaging in high amounts of physical activity during both adolescence and adulthood may derive the most benefit.
Positron emission tomography using 18F-fluorodeoxyglucose (18F-FDG PET) has been proposed to enhance preoperative assessment of cervical lymph node status in patients with head and neck squamous cell carcinoma (HNSCC). Management is most controversial for patients with a clinically negative (cN0) neck. We aimed to assess the diagnostic accuracy of 18F-FDG PET in detecting lymph node metastases in patients with HNSCC.
We performed a meta-analysis of all available studies of the diagnostic performance of 18F-FDG PET in patients with HNSCC. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR–), and constructed summary receiver operating characteristic curves using hierarchical regression models. We also compared the performance of 18F-FDG PET with that of conventional diagnostic methods (ie, computed tomography, magnetic resonance imaging, and ultrasound with fine-needle aspiration) by analyzing studies that had also used these diagnostic methods on the same patients.
Across 32 studies (1236 patients), 18F-FDG PET sensitivity was 79% (95% confidence interval [CI] = 72% to 85%) and specificity was 86% (95% CI = 83% to 89%). For cN0 patients, sensitivity of 18F-FDG PET was only 50% (95% CI = 37% to 63%), whereas specificity was 87% (95% CI = 76% to 93%). Overall, LR+ was 5.84 (95% CI = 4.59 to 7.42) and LR– was 0.24 (95% CI = 0.17 to 0.33). In studies in which both 18F-FDG PET and conventional diagnostic tests were performed, sensitivity and specificity of 18F-FDG PET were 80% and 86%, respectively, and of conventional diagnostic tests were 75% and 79%, respectively.
18F-FDG PET has good diagnostic performance in the overall pretreatment evaluation of patients with HNSCC but still does not detect disease in half of the patients with metastasis and cN0.