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In 1990 an investigation aimed at evaluating the possibility of organizing a regional screening programme for the early detection of cervical cancer was carried out in Liguria. Information on resources available for early detection of cervical cancer was obtained from 12 of 20 Public Health Units; a screening programme was feasible in 8 of them. The number of Pap tests examined was evaluated for 6 of 20 cytology laboratories. Only one laboratory examined more than 20,000 Pap tests in 1989 and, according to the international guidelines, can be a referring centre for screening. However, no information was available concerning inter- and intralaboratory quality control programmes. In the same period a population-based survey was carried out using a self-administered questionnaire in order to evaluate the attitudes of women towards cervical cancer prevention. A total of 1,454 of 4,197 women (35%) participated in the study. Younger, well educated women employed in non non-manual work were more likely to participate in the study. About 65% of the respondents had satisfactory practices with regards to the Pap test, suggesting a strong self-selection that probably resulted in a sample of women more health-conscious than the general population. In conclusion, our results suggest that major interventions should be carried out in the Public Health Units to direct resources to the needs of the population. In addition, new educational methods should be adopted to reach selected population groups to encourage them to have a Pap test performed on a regular basis.

This is a double randomized trial aimed at evaluating the efficacy of antioxidants in reducing the incidence of metachronous adenomas (MA) of the large bowel after endoscopic polypectomy. A 50% reduction in the incidence of MA was expected in patients (pts) allocated to an active compound (intervention) arm as compared to those assigned to a placebo. Eligible for the study were pts aged 25–75 years with a clean colon after adenomas removal. Pts with FAP, invasive carcinoma in adenoma, previous polypectomy, IBD, bowel resection, cancer at any site, life-threatening diseases, current use of vitamins or calcium were excluded. Pts were randomly allocated to receive daily, for 5 years, either an antioxidant compound (selenomethionine 200 g, zinc 30 mg, vitamin A 6000 IU, vitamin C 180 mg and vitamin E 30 mg) or a placebo, both were provided by Pharma Nord. Total Colonoscopy (TC) was planned on year one, three and five after randomization and then according to current guidelines. The primary endpoint of the study was the occurrence of MA detected during TC examinations. The study was approved by the Ethical Committee of the Natl. Institute for Cancer Research of Genoa. Three GI endoscopy units in northern Italy participated in the study. The study started on March 1988 and was stopped on June 1996 when 411 patients had been enrolled. Of them, 200 were assigned to the intervention arm and 211 to the placebo arm. On June 2009, information on survival was available for 396 pts (96.4%); follow up information (at least one TC performed after randomization) was available for 311 pts (80.5%): 165 in the intervention and 166 in the placebo arm. Predictors of MA (gender, age, number of adenomas and rate of advanced adenomas) were similar in pts who had follow up TC and in those who were lost. Of the 311 patients, 144 (43.5%) assumed more than 2/3 of the total amount of the assigned treatment: the rates were similar in the two arms. An intention to treat analysis was performed. The 311 pts provided 1.743 py of follow-up and 98 pts developed MA (2 with invasive carcinoma). The observed incidence of MA was 4.2% (37 cases/886 py) in the intervention arm and 7.2% (62 cases/857 py) in the placebo arm (crude RR=0.56, 95% CI 0.36–0.87; P=0.007). The 15-year actuarial MA-free survival was 48.3% in pts assigned to the intervention arm and 30.5% in those assigned to the placebo arm (P=0.006). A Cox proportional hazard model was fitted to the data and GI endoscopy unit, gender, age, number of adenomas, presence of advanced adenoma were included in the model as covariates: a 41% reduction in the risk of MA was observed in the intervention as compared to the placebo arm (HR=0.59, 95% CI 0.39–0.90; P=0.013). Among pts who had advanced adenomas at randomization, those assigned to the intervention arm had a 10-fold lower risk of advanced MA as compared to those assigned to the placebo (RR=0.11, 95%CI 0.02–0.49; P=0.004). To our knowledge, this is the first time that a specifically designed trial shows the persistence of a statistically significant reduction of colorectal MA in pts treated with a selenium-based antioxidant compound long time after the treatment cessation. In particular, the effect observed in pts with advanced index adenoma is intriguing. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A80.

Seventeen patients with non-resectable circumferential malignant strictures of the esophagus (n = 13) or the gastroesophageal junction (n = 4) were treated with a bipolar electrocoagulation tumor probe (BICAP). None had received prior radiotherapy or chemotherapy. The mean tumor length was 7.2 cm. After treatment swallowing was improved in 86.7% of the patients. The mean duration of response to the first treatment was 18 days. Three major complications (1 fatal hemorrhage, 2 tracheoesophageal fistulae) and two minor complications (chest pain) were observed. The overall actuarial survival rate after 13 months of follow-up was 20%. The BICAP tumor probe can be considered an efficacious and safe device in selected patients with long, circumferential esophageal cancers.

A cooperative randomized study was begun in August 1983 to compare a sequential program of induction chemotherapy followed by definitive treatment, arm A, with an alternation of chemotherapy and radiotherapy (three courses of 20 Gy in ten daily fractions), arm B. The same chemotherapy was used in both arms: 6 mg/m2, vinblastine, hour 0; 30 mg, bleomycin, hour 6; 200 mg, methotrexate, hours 24 to 26; 45 mg, leucovorin, hour 48. One hundred sixteen patients entered the study, 55 in arm A and 61 in arm B. The patients all had previously untreated squamous cell carcinoma of the head and neck (SCCHN). Forty-five patients had stage III and 71 had stage IV disease. The two arms were fully comparable. As of April 1986, 116 patients were evaluable for survival, while 112 were evaluable for toxicity and 105 for response. Response analysis shows that there were 14 complete responses (CR) and 11 partial responses (PR), for an overall response rate (ORR) of 52% in arm A, and 30 CRs and seven PRs, for an ORR of 64.9% in arm B. The difference in terms of CR between the two arms was statistically significant (P less than .03). Progression-free survival (PFS) was also statistically different, with an advantage for arm B (P less than .05), but without differences in overall survival. Arm B correlates with a significant increase in mucositis compared with arm A (P less than .001).

A final diagnosis of pancreatic cancer was established in 76 consecutive patients during 4 years. The clinical outcome was evaluated retrospectively, as well as clinical presentation and its impact on the rate of resectability. Even though the diagnostic techniques showed a high sensitivity, only 18.4% of patients had a radical resection performed. In 77.6% of the cases a tissue diagnosis had been obtained. However, in only 1/5 of them was the tissue proof obtained preoperatively. This review confirms that the survival of patients with pancreatic cancer is poor, with slight advantages in the few resectable cases. Therefore, an earlier diagnosis should be attempted in high-risk symptomatic patients, selected by means of nonaggressive tests and evaluated by means of more accurate diagnostic techniques, when suitable.

102 patients symptomatiques consecutifs (57 hommes et 45 femmes) souffrant de reflux gastro-œsophagien ont subi une endoscopic avec biopsies muqueuses multiples de l’œsophage inferieur. 12 malades (11,8 %) ont presente a l’examen histologique, une metaplasie de type cylindrique indiscutable. L’œsophagite et la hernie hiatale compliquee d’œsophagite etaient les situations cliniques le plus souvent associees chez les malades porteurs d’un endobrachy-œsophage (E.B.).

Between August 1979 and August 1984, 46 untreated, inoperable patients with advanced squamous cell carcinoma of the head and neck were submitted to a combined modality of treatment based on four courses of polychemotherapy (vincristine, bleomycin, and methotrexate), rotated with three courses of radiotherapy, 20 Gy each. Forty-six patients entered the study: 45 were evaluable for their response to the treatment and 46 for toxicity effects. We observed 26 complete responses (57.7%) and 14 partial responses (31.1%); overall actuarial survival was 28% at 55 months. Mucositis occurred in 11 patients, 3 patients suffered from nausea and vomiting, 2 patients developed fever, and 1 had a platelet count of 50,000/mm3. One toxic death occurred: one patient developed an acute renal failure related to Methotrexate.

170 patients souffrant de symptomes evocateurs d’affection des voies biliaires ont ete soumis a la fois a une angiocholographie intraveineuse et une cholangiographie retrograde. Les images radiologiques ont ete examinees par une equipe reunissant radiologue et gastroenterologue et les donnees furent traitees en fonction des taux d’explorations intraveineuses inadequates (22,35 %) et d’echecs d’examens endoscopiques retrogrades (10,58 %). Les taux de sensibilite, de specificite et de valeur predictive des deux techniques ont egalement ete analyses, uniquement sur base des patients dont le diagnostic a ete etabli par verification chirurgicale. La cholangiographie retrograde a un rendement diagnostique de loin superieur tant dans la pathologie obstructive des voies biliaires (calculs, stenoses) que non-obstructive (fistules, « sump syndrome », compression extrinseque). Les auteurs concluent que la cholangiographie intraveineuse est une technique non satisfaisante en raison de son taux eleve de resultats inadequats et de son faible rendement diagnostique. C’est pourquoi l’exploration intraveineuse devrait etre remplacee en routine par l’investigation endoscopique tant en presence qu’en l’absence d’ictere. One hundred and seventy patients complaining of symptoms suggestive of biliary tract disease had been evaluated by means of both intravenous and endoscopie retrograde cholangiography. The radiological series were reviewed by a staff radiologist and a gastroenterologist altogether and the data were drawn as to the rate of inadequate intravenous studies (22.35 %) and of unsuccessful endoscopie retrograde examinations (10.58 %). Sensitivity, specificity and predictive values of the two techniques were also analyzed, limited to patients with surgical verification of diagnosis. Endoscopie cholangiography gave a far better yield either in obstructive (stones, strictures) and in nonobstructive (fistulas, sump syndrome, extrinsic compression) diseases of the biliary tract. It is concluded that intravenous cholangiography is an unrewarding technique because of both a high rate of inadequate studies and a low diagnostic accuracy. Therefore, this study should be routinely replaced by the endoscopie technique irrespective of the presence or absence of jaundice.

The survival of a group of 115 patients (group A) who entered a follow-up program after apparently « curative » surgery for colorectal cancer was compared with that of 62 similar patients (group B) who did not join such a program. No significant difference was found. Clinical benefits to single patients in group A, in terms of anticipated diagnosis and effective treatment of recurrences and of metachronous neoplasias, appeared to be, if any, extremely limited. In light of the high costs of intensive follow-up programs, it is concluded that their use can be justified only within controlled perspective trials aimed to evaluate their usefulness.

The relationship between first degree family history of colorectal cancer and the risk of benign or malignant tumours of the large bowel was investigated in a case-control study. Two groups of cases (283 patients with adenomatous polyps and 414 patients with adenocarcinoma of the large bowel) and 2 groups of controls (399 polyp-free subjects and 456 hospitalized patients) were interviewed. Since no difference in the frequency of family history between the 2 control groups was detected, these were lumped together. A 3-fold increase in risk of adenomatous polyps in relatives of patients with colon cancer was observed (OR = 3.18, 95% CI 2.06-4.89). The relative risk of colorectal cancer among relatives of patients with adenocarcinoma was 2.36 (95% CI 1.54-3.60). No significant difference in the frequency of first degree relatives with a history of cancer of the large bowel was detected between patients with colorectal cancer and those with adenomatous polyps. When only history of colorectal cancer among parents was considered, the results closely paralleled those of the previous analysis.

The frequency of colonic adenomatous polyps and the incidence of colorectal cancer in close relatives were evaluated in a prospective study performed in 100 consecutive patients operated on for colorectal cancer. One hundred patients matched for age and sex, in whom double contrast enema and colonoscopy failed to show cancer, served as control group. Colorectal carcinomas in first-degree relatives were found in 11% of the surgically treated patients and 6% of the control group (the difference is not statistically significant). Solitary or discrete adenomas in patients operated on for colorectal carcinomas were significantly more frequent (32%) than in the control group (18%) (P less than 0.05). This difference is also statistically significant when considering only those patients without relatives suffering from carcinoma; however, the same cannot be statistically proven with the small group of patients with a positive family history. Present findings do not indicate that single or discrete adenomas synchronous with colorectal cancer are significantly associated with a familial history of large bowel malignancy. These findings are consistent with the hypothesis of environmental factors being involved in adenoma pathogenesis.

The relationship between first degree family history of colorectal cancer and some pathological and clinical features was investigated in 302 patients affected by large bowel carcinoma. Patients with inherited forms of polyposis of the large bowel were excluded. Thirty-six (11.9%) had at least one close relative affected by intestinal cancer. No relationship between family history and pathological features (anatomic distribution, stage and grading) was found. Moreover no difference in prognosis between patients with a family history and those without was shown. These results suggest no relationship between a first degree family history and the natural history of the disease.

Between August 1979 and August 1984, 47 consecutive patients with recurrent squamous cell carcinoma of the head and neck entered one of three consecutive second-line treatments. Response rates with each treatment were very different (70 % vs 5.9 % vs 75 %), but there was no statistical difference in actuarial survival (survival: 30 % vs 29 % vs 20 %, respectively, at 260 days). In light of this observation, the efficacy of the second-line therapy appears doubtful and the survival of relapsing patients seems unrelated to the response achieved.

Objective:To investigate the relationship between socioeconomic characteristics, life style (coffee, alcohol and tobacco consumption), diabetes mellitus, first-degree family history of cancer and risk of exocrine pancreatic cancer.Design:Hospital-based case-control study.Methods:One hundred and fift