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Background.Mass screening for cervical cancer has considerably reduced invasive cancer rates; however, Hispanic Americans have not fully benefited. This study examined the relationship of demographic, socioeconomic, and acculturation factors to diagnostic stage prior to preventive interventions in a large Hispanic community (San Diego, CA, 1988–1991). Methods.Age-adjusted incidence rates (IR) were estimated for three subareas: Hispanic community targeted with interventions, comparison Hispanic community, and remainder of county. Incident cases of cervical cancer in the California Cancer Registry were used to calculate incidence rate ratios (IRR) ofin situto invasive stage cancer and estimate differences in early detection between Hispanics and white non-Hispanics. Multiple logistic regression was used to examine the relationship of cancer stage to census-linked income, education, poverty status, foreign birth, and language spoken. Results.Thein situcervical cancer IR is significantly lower for Hispanics than for white non-Hispanics in all three regions (P< 0.05). The overall IRR is 3.65 (95% CI 3.19, 4.18) for white non-Hispanics compared with 1.09 (95% CI 0.86, 1.38) for Hispanics. Hispanics in census tracts in the highest versus remaining quartiles for percentage of language-isolated households are at greater risk for invasive stage (OR = 2.10, 95% CI 1.27, 3.40). White non-Hispanic women residing in census tracts in the highest versus lowest quartile of adults with less than 12 years education are at greater risk for invasive stage (OR = 2.10, 95% CI 1.31, 3.38). Conclusions.Results show efforts aimed at cervical cancer early detection for Hispanic women are needed and well targeted. White non-Hispanic women in low-education communities are also at risk. Population-based methods in this study can focus efforts in communities needing preventive interventions.

The incidence of breast cancer in the U.S. is lower among Hispanic women than non-Hispanic white women. However, population-based studies show that Hispanic women are more likely to be diagnosed at a later stage than non-Hispanic whites. We aimed to determine whether: 1) a lower proportion of breast cancer was diagnosed at early vs. late stages in Hispanic compared to non-Hispanic white women from 1988-93 in San Diego County, and 2) lower income is related to later stage at diagnosis for both groups. All incident cases of breast cancer in San Diego County from the California Cancer Registry (10,161 cases) were stratified by 'early' (in situ or localized) or 'late' (regional or distant) stage, and by race/ethnicity. Annual average age-adjusted incidence rates/100,000 (AAIR) were calculated. Incidence rate ratios (IRR) (AAIR for early stages divided by AAIR for late stages) were used as a surrogate of early detection. AAIRs for early and late stage disease were significantly higher for non-Hispanic whites (89.3, 42.3) than Hispanic women (46.7, 27.2). The IRR was significantly higher for non-Hispanic whites than Hispanics, (2.11 vs 1.72, p = 0.01). This difference was greatest among women under 50 years old (IRR difference 0.63), and not apparent for women 65 or older (IRR difference 0.06). There was also an association between increasing census tract per capita income and higher rates of early stage disease among non-Hispanic whites but not Hispanics. Results suggest that Hispanic women and lower income women should be targeted for early detection.

BACKGROUND It is suspected that young patients with adenocarcinoma have a more aggressive form of disease and therefore a poorer prognosis than older patients. METHODS A retrospective cohort study used the population-based tumor registries of Orange, San Diego, and Imperial Counties. Cases (patients age ≤40 years with gastric carcinoma) were compared with controls (patients age >40 years with gastric carcinoma). RESULTS The overall, age-adjusted incidence rate of gastric carcinoma was 10.2/100,000. Approximately 5.5% of 3,020 cases occurred in patients age 70 years had an independent increased risk of dying from all causes in comparison with young patients (relative risk = 1.46; P = 0.01). CONCLUSIONS Young gastric carcinoma patients have adverse clinical and pathologic features in comparison with older patients. In this study, young age was not found to be an independent predictor of overall survival. Cancer 1998;83:25-33. © 1998 American Cancer Society.

Introduction: Geographic and racial/ethnic variability in prostate cancer incidence rates and stage distribution may be partly attributed to differences in screening and early detection. Methods: Using California Cancer Registry data we aimed to characterize variability in prostate cancer rates statewide and to examine differences in the stage at diagnosis of prostate cancer by racial/ethnic group statewide and by census tract per capita income in San Diego County. We calculated annual average (1988–1991) age-adjusted incidence rates per 100,000 (AAIR) of prostate cancer for 49,880 men over age 34 years. Racial/ethnic groups were compared using incidence rate ratios (IRR) (AAIR localized plus regional stages ÷ AAIR distant stage). Results: Statewide, Caucasians showed a higher IRR [6.16, 95% confidence interval (CI), 6.00–6.30] than did African Americans (2.34, 95% CI, 1.89–2.89), Hispanics (3.84, 95% CI, 3.63–4.05), or Asian/others (3.61, 95% CI, 1.80–7.22). Within San Diego County, Caucasians living in higher per capita income census tracts (≥65th percentile) had a significantly higher IRR (8.80, 95% CI 7.84–9.89) than did lower-income tracts (5.68, 95% CI, 5.13–6.30). Conclusion: Findings from the present and similar studies suggest that outcomes research is needed to determine the impact of these demographic differences on prostate cancer mortality and quality of life. This is particularly important given the current controversy regarding the treatment of clinically localized prostate cancers, increasingly found through early detection, which often involve difficult choices between aggressive therapies including prostatectomy or watchful waiting.

BACKGROUND Most reports about respiratory syncytial virus (RSV) in developing countries rely on sentinel surveillance, from which population incidence is difficult to infer. We used the proportion of RSV infections from population-based surveillance with data from a healthcare utilization survey to produce estimates of RSV incidence in Damanhour district, Egypt. METHODS We conducted population-based surveillance in 3 hospitals (2009-2012) and 3 outpatient clinics (2011-2012) in Damanhour district. Nasopharyngeal and oropharyngeal specimens from hospitalized patients with acute respiratory illness and outpatients with influenza-like illness were tested by real-time reverse transcriptase polymerase chain reaction for RSV. We also conducted a healthcare utilization survey in 2011-2012 to determine the proportion of individuals who sought care for respiratory illness. RESULTS Among 5342 hospitalized patients and 771 outpatients, 12% and 5% tested positive for RSV, respectively. The incidence of RSV-associated hospitalization and outpatient visits was estimated at 24 and 608 (per 100 000 person-years), respectively. Children aged

Since the establishment of sequence-based typing as the gold standard for DNA-based typing of Legionella pneumophila , the Legionella laboratory at the Centers for Disease Control and Prevention (CDC) has conducted routine sequence-based typing (SBT) analysis of all incoming L. pneumophila serogroup 1 (Lp1) isolates to identify potential links between cases and to better understand genetic diversity and clonal expansion among L. pneumophila bacteria. Retrospective genotyping of Lp1 isolates from sporadic cases and Legionnaires' disease (LD) outbreaks deposited into the CDC reference collection since 1982 has been completed. For this study, we compared the distribution of sequence types (STs) among Lp1 isolates implicated in 26 outbreaks in the United States, 571 clinical isolates from sporadic cases of LD in the United States, and 149 environmental isolates with no known association with LD. The Lp1 isolates under study had been deposited into our collection between 1982 and 2012. We identified 17 outbreak-associated STs, 153 sporadic STs, and 49 environmental STs. We observed that Lp1 STs from outbreaks and sporadic cases are more similar to each other than either group is to environmental STs. The most frequent ST for both sporadic and environmental isolates was ST1, accounting for 25% and 49% of the total number of isolates, respectively. The STs shared by both outbreak-associated and sporadic Lp1 included ST1, ST35, ST36, ST37, and ST222. The STs most commonly found in sporadic and outbreak-associated Lp1 populations may have an increased ability to cause disease and thus may require special attention when detected.

Oral premalignancy serves as an ideal model for study of chemopreventive agents. Although 13-cis-retinoic acid showed reversal of oral premalignancy, toxicity, and reversal of clinical response after cessation of therapy obviated its widespread use. A search for nontoxic agents with cancer preventive activity led us to evaluate Bowman Birk Inhibitor (BBI) formulated as BBI Concentrate (BBIC). We previously reported encouraging results in a phase IIa trial of BBIC in patients with oral leukoplakia with measurable clinical responses and favorable biomarker changes. On the basis of these results, we undertook a randomized, placebo controlled phase IIb trial with patients receiving BBIC or placebo for 6 months, with assessment of clinical response and change in lesion area as primary end point and an intent-to-treat analysis. One hundred and thirty two subjects were randomized; and 89 subjects completed six months on study drug or placebo. Both placebo and BBIC showed a statistically significant decrease in mean lesion area of 17.1% and 20.6%, respectively, and partial or greater clinical responses of 30% and 28% respectively. No significant difference between placebo and study drug arms was observed. Histologic review, review of photographs of lesions, and comparison of serum neu protein and oral mucosal cell protease activity also did not show significant differences between study arms. Probable reasons for these negative results were considered, are discussed, and include a placebo with non-BBIC clinical activity and reduced pharmacokinetic availability of the second batch of BBIC. This experience should be a strong cautionary note to those considering “Green” chemoprevention. Cancer Prev Res; 6(5); 410–8. ©2013 AACR.

BACKGROUND: African Americans and Hispanics are reported to have higher mortality from esophageal cancer (EC) than Caucasians. In this study, we analyzed the independent effects of race, gender, treatment, and socioeconomic status (SES) on overall survival (OS). METHODS: Data for all EC cases between 2004 and 2010 with follow-up through 2012 were obtained from the California Cancer Registry. We conducted descriptive analyses of clinical variables and survival analyses by Kaplan–Meier and Cox proportional hazards methods. RESULTS: African Americans and Hispanics were more likely to be in the lower SES strata and less likely to receive surgery than Caucasians in this cohort. The proportion of patients receiving chemotherapy and radiotherapy was similar across different racial/ethnic groups. After adjustment for stage, grade, histology, treatments, and SES in multivariate analyses, the mortality risk in African Americans (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.85–1.07) and Hispanics (HR 0.96, 95% CI 0.89–1.07) did not differ from Caucasians (HR = 1.00, referent), with histology, SES, and surgery largely accounting for unadjusted OS differences. We also observed that African American men had higher adjusted risk of death relative to Caucasian men (HR 1.24, 95% CI 1.07–1.42), but this effect was not observed for African American women compared to Caucasian women (HR 1.12, 95% CI 0.94–1.35). CONCLUSIONS: Race is not an independent risk factor for OS in our population-based analysis of EC cases. Rather, observed differences in OS by race/ethnicity result from differences in cancer histology, SES, surgery, and gender. Our findings support further health disparities research for this disease.

Background EarlyCDT®-Lung Test detects autoantibodies to abnormal cell surface proteins from the early stages of lung cancer with a specificity of 93%. This may allow earlier tumour detection thus altering prognosis. The primary research question is: Does using the EarlyCDT®-Lung Test to identify those at high risk of lung cancer, followed by xray and CT scanning in the test positive group, reduce the incidence of patients with late-stage lung cancer (III and IV) or unclassified presentation (U) at diagnosis, compared to standard practice? Recruitment was completed in June 2016 with 12,018 subjects randomised. Methods A RCT in Scotland recruiting from the most socially disadvantaged quintiles. Adults aged 50 to 75 (ECOG 0–2) who were at high risk for lung cancer (>20 pack years or relevant family history) were eligible. The intervention was the EarlyCDT®-Lung Test, followed by chest xray and CT in those with a positive result. The comparator is standard clinical practice in the UK. The primary outcome is the difference, after 24 months, between the rates of patients with stage III, IV or unclassified lung cancer at diagnosis in test v no-test group. Secondary outcomes include: all-cause mortality; cancer specific mortality; a range of morbidity outcomes; cost-effectiveness and measures examining the psychological and behavioural consequences of screening. Participants with a positive test result had an initial chest xray which was used to determine the urgency and the need for contrast in the initial screening CT. Those in whom the initial CT scan did not lead to a lung cancer diagnosis were offered biannual chest CTs for 24 months. Participants who are found to have lung cancer will be followed-up to assess both time to diagnosis and stage of disease at diagnosis. Results 575/6120 (9.8%) of the test group had a positive test with 207 found to have lung nodules >8 mm, 16 cancers have been detected so far, 12 of which are at early stage. Eleven have abnormalities undergoing current investigation. At this stage of the trial we have no outcome data for the comparison group. Conclusion The study will determine EarlyCDT-Lung test’s clinical and cost effectiveness.

Objectives Although antibiotic prescriptions are decreasing in the United States, broad-spectrum prescribing is increasing. It is unknown if decreases observed in national antibiotic prescribing differ by provider group. Understanding prescribing trends over time by provider group can be helpful for customizing antimicrobial stewardship efforts. Therefore, the purposes of this study were to describe outpatient antibiotic prescribing by provider group overall and adjusted for population and number of providers. In addition, trends in prescribing by class and seasonal variation are described by provider group over 6 years. Design Cross-sectional observation of outpatient antibiotic prescriptions. Setting and participants A population-level analysis of U.S. prescribing from 2005 to 2010 with the use of the IMS Health Xponent dataset. Main outcome measures Number and rates of prescriptions dispensed overall and by provider group. Results The majority (81.0%) of antibiotics were prescribed by physicians, followed by dentists (10.4%), nurse practitioners (NPs; 4.5%), and physician assistants (PAs; 4.2%). The percentage of antibiotic prescriptions decreased for physicians, but increased significantly for NPs and PAs. Provider-based and population-based prescribing rates decreased for physicians and dentists and increased for NPs and PAs. Penicillins were prescribed most frequently by all provider groups, decreasing for physicians and dentists. Increased prescribing of broad-spectrum agents was observed for NPs and PAs. With the exception of dentists, antibiotic prescriptions were higher in winter than in summer, with the largest seasonal increase by NPs. Conclusion Over 6 years, antibiotic prescriptions overall and for broad-spectrum agents decreased for physicians and increased for NPs and PAs. Thus, increasing trends in the US of broad-spectrum antibiotic prescriptions can be attributed to midlevel providers. Interventions should be designed to reverse increasing prescribing trends, especially of broad-spectrum agents prescribed by NPs and PAs. Stewardship efforts should also be targeted towards dentists, since this group prescribes a higher proportion of antibiotics compared with midlevel providers.

1562Background: Esophageal cancer (EC) claims 15,000 lives annually in the U.S. African-American (AA) race and low SES have been suggested as poor prognostic factors. However, it is not clear to wh...

A case of pneumonia due to Legionella bozemanii--only the 20th culture-proven case reported so far--progressed with cavitation 9 days after the initiation of intravenous therapy with erythromycin. Review of all 20 reported cases revealed a similar propensity toward radiographic progression (25%) and cavitation (25%) during therapy. A slow response to long courses of erythromycin was the rule (35% of cases). In two instances, long courses of intravenous erythromycin failed and the patient died. Pleural effusion was reported in 60% of patients, including two with empyema. Overall mortality was high (40%). Although mortality was only 21% among patients who lived long enough to receive adequate courses of erythromycin, all three such patients who died had received erythromycin alone. Combination therapy with erythromycin and rifampin proved more effective in terms of survival. Infections due to non-pneumophila Legionella may be overlooked because of the organisms' special serological and culture requirements.

In estimates of illness severity from the spring wave of the 2009 influenza A (H1N1) pandemic, reported case fatality proportions were less than 0.05%. In prior pandemics, subsequent waves of illness were associated with higher mortality. The authors evaluated the burden of the pandemic H1N1 (pH1N1) outbreak in metropolitan Atlanta, Georgia, in the fall of 2009, when increased influenza activity heralded the second wave of the pandemic in the United States. Using data from a community survey, existing surveillance systems, public health laboratories, and local hospitals, they estimated numbers of pH1N1-associated illnesses, emergency department (ED) visits, hospitalizations, intensive care unit (ICU) admissions, and deaths occurring in metropolitan Atlanta during the period August 16, 2009–September 26, 2009. The authors estimated 132,140 pediatric and 132,110 adult symptomatic cases of pH1N1 in metropolitan Atlanta during the investigation time frame. Among children, these cases were associated with 4,560 ED visits, 190 hospitalizations, 51 ICU admissions, and 4 deaths. Among adults, they were associated with 1,130 ED visits, 590 hospitalizations, 140 ICU admissions, and 63 deaths. The combined symptomatic case hospitalization proportion, case ICU admission proportion, and case fatality proportion were 0.281%, 0.069%, and 0.024%, respectively. Influenza burden can be estimated using existing data and local surveys. The increased severity reported for subsequent waves in past pandemics was not evident in this investigation. Nevertheless, the second pH1N1 pandemic wave led to substantial numbers of ED visits, hospitalizations, and deaths in metropolitan Atlanta.

Using US SEER17 Registry data, age-specific melanoma incidence rates were calculated and comparisons were made between males and females. Relative Risk (RR) for males and females in each age group was computed and compared with that from Nordic Cancer Registry data set and to that for non-melanoma skin cancer (NMSC). For age groups 44 and younger, females showed higher incidence rates, with a peak difference at age 20-24 (RR = 2.01, 95% CI = 1.21-3.33). Males exhibited higher incidence rates after age 44. The same bimodal gender difference was confirmed by the Nordic Cancer Registry data set, but it was not observed for NMSC, which is known to be strongly associated with cumulative exposure to solar UV radiation. We conclude that exposure to solar ultraviolet (UV) radiation is the major causative factor for melanoma at older age (>44 yr), but that other factors may play a role in early onset melanomas, particularly in females. © 2012 John Wiley & Sons A/S.

OBJECTIVE: Streamlining the initiation of allopurinol could result in a cost benefit for a common medical problem and obviate the perception that no treatment is required once acute attacks have resolved. Our objective was to test the hypothesis that there is no difference in patient daily pain or subsequent attacks with early versus delayed initiation of allopurinol for an acute gout attack. METHODS: A total of 57 men with crystal-proven gout were randomized to allopurinol 300 mg daily or matching placebo for 10 days. All subjects received indomethacin 50 mg 3 times per day for 10 days, a prophylactic dose of colchicine 0.6 mg 2 times per day for 90 days, and open-label allopurinol starting at day 11. Primary outcome measures were pain on visual analogue scale (VAS) for the primary joint on days 1 to 10 and self-reported flares in any joint through day 30. RESULTS: On the basis of 51 evaluable subjects (allopurinol in 26, placebo in 25), mean daily VAS pain scores did not differ significantly between study groups at any point between days 1 and 10. Initial VAS pain scores for allopurinol and placebo arms were 6.72 versus 6.28 (P .37), declining to 0.18 versus 0.27 (P .54) at day 10, with neither group consistently having more daily pain. Subsequent flares occurred in 2 subjects taking allopurinol and 3 subjects taking placebo (P .60). Although urate levels decreased rapidly in the allopurinol group (from 7.8 mg/dL at baseline to 5.9 mg/dL at day 3), sedimentation rates and C-reactive protein levels did not differ between groups at any point. CONCLUSIONS: Allopurinol initiation during an acute gout attack caused no significant difference in daily pain, recurrent flares, or inflammatory markers.

Background The epidemiology of streptococcal infection in pregnant and postpartum women is poorly described in recent literature. We used data from multistate surveillance for invasive Streptococcus pneumoniae, group A Streptococcus (GAS), and group B Streptococcus (GBS) infections to estimate disease incidence and severity in these populations. Methods Cases were reported through the Centers for Disease Control and Prevention Active Bacterial Core surveillance, an active population- and laboratory-based system. A case was defined as illness in a woman aged 15-44 years with streptococcus isolated from a normally sterile body site during 2007-2009. Pregnant or postpartum status was recorded at the time of culture. Incidence was calculated as cases per 1000 woman-years with use of national Census data; 95% confidence intervals were calculated on the basis of λ distribution. We used multivariable logistic regression to explore associations between pregnant or postpartum status and hospital length of stay, a marker of disease severity. Results We identified 1848 cases in women; 6.0% of women were pregnant, and 7.5% were postpartum. Pregnant women had a higher mean incidence of GBS disease, compared with nonpregnant women (0.04 cases per 1000 woman-years [range, 0.03-0.05 cases per 1000 woman-years] vs 0.02 cases per 1000 woman-years [range, 0.02-0.02 cases per 1000 woman-years]). Postpartum women had elevated mean incidence of all 3 pathogens, compared with nonpregnant women (S. pneumoniae: 0.15 cases per 1000 woman-years [range, 0.09-0.25 cases per 1000 woman-years] vs 0.052 cases per 1000 woman-years [range, 0.049-0.056 cases per 1000 woman-years]; GAS: 0.56 cases per 1000 woman-years [range, 0.42-0.70 cases per 1000 woman-years] vs 0.019 cases per 1000 woman-years [range, 0.017-0.021 cases per 1000 woman-years]; GBS: 0.49 cases per 1000 woman-years [range, 0.36-0.64 cases per 1000 woman-years] vs 0.018 [range, 0.016-0.020 cases per 1000 woman-years]). Neither pregnancy nor postpartum status was associated with longer length of stay among women infected with any of the 3 pathogens. Conclusions Although invasive streptococcal infections do not appear to be more severe in pregnant or postpartum women, postpartum women have a 20-fold increased incidence of GAS and GBS, compared with nonpregnant women.

Objectives: Hormone-receptor (HR) and HER2/neu-receptor (HER2) status of breast tumors are important indicators for targeted therapies. We examine the association of receptor status and risk for a second breast cancer. Methods: We analyzed data on 106,331 women in the California Cancer Registry whose first cancer is locoregional invasive breast disease, diagnosed from 1999 through 2005, yielding 1,613 second primary breast cancers. Standardized incidence ratios (SIR) with 95% confidence intervals (CIs) were used to evaluate risk of second tumors, accounting for age at first diagnosis, duration at risk, and race/ethnicity. Results: Among non-Hispanic whites, HR-positive first tumors signal a reduction in risk for second breast cancers (SIR = 0.83, 95% CI: 0.77–0.89) whereas HR-negative status signals elevated risk (SIR = 1.48, 95% CI: 1.29–1.70). Asian/Pacific Islanders, African Americans, and Hispanics are at elevated risk of second breast cancers regardless of HR status of the first tumor. Hispanics with HR-negative first tumors are at greater risk than those with HR-positive disease (HR−: SIR = 3.76, 95% CI: 2.97–4.71; HR+: SIR = 1.86, 95% CI: 1.56–2.20). HER2 status does not differentiate risk for second tumors in any group examined. Conclusions: HR status of a first breast cancer is a marker for risk of a second breast cancer. HER2 status does not seem to be a marker of risk for a second breast cancer. Risk differences across race/ethnic groups by HR status suggest heterogeneity of breast cancers across race/ethnicity. Impact: These data suggest that HR status may be helpful in shaping strategies to reduce risk of a second breast cancer, while HER2 status seems uninformative for this purpose. Cancer Epidemiol Biomarkers Prev; 20(2); 389–96. ©2011 AACR.

This study examined patterns of invasive bladder cancer by ethnicity and gender. Odds ratios were computed by comparing 593 patients of known smoking status and diagnosed during the period from 1984 to 1988 with a randomly selected referent group using a logistic regression model that adjusted for differences in age and current occupation. Age-adjusted incidence rates for non-Hispanic whites were approximately twice those of Hispanics and Asian and Pacific Islanders. After adjustment for smoking and occupational exposures, the risks did not differ significantly, indicating that ethnic differences in bladder cancer incidence may be related to smoking and occupational exposures. The odds ratio for males relative to females was 5.95 (95% confidence interval (CI), 4.36 to 8.12), after adjustment for ethnicity, smoking status, occupation, and age, suggesting that gender differences not previously identified may play an important role in the etiology of bladder cancer. Odds ratios associated with amount smoked per day, for current smokers relative to nonsmokers, ranged from 1.04 for those smoking less than 1 pack per day (95% CI, 0.62 to 1.71) to 6.84 for those smoking 2 or more packs per day (95% CI, 4.67 to 10.03).

A pilot study for the Environmental Legionella Isolation Techniques Evaluation (ELITE) Program, a proficiency testing scheme for US laboratories that culture Legionella from environmental samples, was conducted September 1, 2008 through March 31, 2009. Participants (n=20) processed panels consisting of six sample types: pure and mixed positive, pure and mixed negative, pure and mixed variable. The majority (93%) of all samples (n=286) were correctly characterized, with 88.5% of samples positive for Legionella and 100% of negative samples identified correctly. Variable samples were incorrectly identified as negative in 36.9% of reports. For all samples reported positive (n=128), participants underestimated the cfu/ml by a mean of 1.25 logs with standard deviation of 0.78 logs, standard error of 0.07 logs, and a range of 3.57 logs compared to the CDC re-test value. Centering results around the interlaboratory mean yielded a standard deviation of 0.65 logs, standard error of 0.06 logs, and a range of 3.22 logs. Sampling protocol, treatment regimen, culture procedure, and laboratory experience did not significantly affect the accuracy or precision of reported concentrations. Qualitative and quantitative results from the ELITE pilot study were similar to reports from a corresponding proficiency testing scheme available in the European Union, indicating these results are probably valid for most environmental laboratories worldwide. The large enumeration error observed suggests that the need for remediation of a water system should not be determined solely by the concentration of Legionella observed in a sample since that value is likely to underestimate the true level of contamination.

Purpose We sought to compare the quality of life (QOL), characteristics, and survival of patients with non-Hodgkin lymphoma (NHL) with and without human immunodeficiency virus (HIV) infection. Methods Using the population-based cancer registry for Orange and San Diego Counties, We recruited 50 patients with HIV and systemic NHL (cases) and 50 age, sex and race-matched NHL patients without HIV (controls) diagnosed with NHL during 2002–2006. Patients completed a medical history survey and QOL instrument, the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) for cases and Functional Assessment of Cancer Therapy-General (FACT G) for controls. Results HIV-infected patients had worse overall QOL and survival than uninfected patients. QOL differences were more marked in the areas of functional, physical and social well-being than in the area of emotional well-being. HIV-infected patients had lower income and were less likely to have private insurance and more likely to have diffuse large B cell histology than uninfected patients. Conclusion HIV-infected NHL patients had worse QOL and survival than uninfected patients, due to a combination of co-morbidity, aggressive histology and lack of social support. However, their emotional well-being was comparable to that of uninfected NHL patients and better than historical norms for the HIV-infected.

This study examines the estimated risk of bladder cancer associated with various occupations among 1,465 cases identified in Orange County, California, during 1984-1988. The annual age-adjusted incidence rate per 100,000 population in Orange County was similar to that of the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute: 25.7 in males and 6.2 in females. Cases were compared with a sample of Orange County residents relative to broad category of current occupation, adjusted for age and cigarette smoking. The estimated relative risks were significant for males in machine trades (relative risk (RR) = 2.69, 95% confidence interval (CI) 1.24-5.82) and processing occupations (RR = 5.77, 95% CI 1.43-23.27) and for females in machine trades (RR = 8.34, 95% CI 1.14-61.17) and homemakers (RR = 5.37, 95% CI 2.40-11.99) as compared with individuals of the same sex in professional, technical, and managerial occupations.

Rates of invasive pneumococcal disease in the United States increase dramatically during winter holidays. The authors analyzed population-based surveillance data to determine whether spikes may be ...

BACKGROUND Animal models and data from influenza pandemics suggest that influenza infection predisposes individuals to pneumococcal pneumonia. Influenza may contribute to high winter rates of pneumococcal pneumonia during non-pandemic periods, but the magnitude of this effect is unknown. With use of United States surveillance data during 1995-2006, we estimated the association between influenza circulation and invasive pneumococcal pneumonia rates. METHODS Weekly invasive pneumococcal pneumonia incidence, defined by isolation of pneumococci from normally sterile sites in persons with clinical or radiographic pneumonia, was estimated from active population-based surveillance in 3 regions of the United States. We used influenza virus data collected by World Health Organization collaborating laboratories in the same 3 regions in seasonally adjusted negative binomial regression models to estimate the influenza-associated fraction of pneumococcal pneumonia. RESULTS During approximately 185 million person-years of surveillance, we observed 21,239 episodes of invasive pneumococcal pneumonia; 485,691 specimens were tested for influenza. Influenza circulation was associated with 11%-14% of pneumococcal pneumonia during periods of influenza circulation and 5%-6% overall. In 2 of 3 regions, the association was strongest when influenza circulation data were lagged by 1 week. CONCLUSIONS During recent seasonal influenza epidemics in the United States, a modest but potentially preventable fraction of invasive pneumococcal pneumonia was associated with influenza circulation.

Introduction: Inflammatory breast cancer (IBC) is an aggressive form of breast cancer associated with overexpression of Her2/Neu (human epidermal growth factor-like receptor 2 (HER2)) and poor survival. We investigated survival differences for IBC patient cases based on hormone receptor status and HER2 receptor status using data from the California Cancer Registry, as contrasted with locally advanced breast cancer (LABC), metastatic breast cancer (MBC) and non-T4 breast cancer.Methods: A case-only analysis of 80,099 incident female breast cancer patient cases in the California Cancer Registry during 1999 to 2003 was performed, with follow-up through March 2007. Overall survival (OS) and breast cancer-specific survival (BC-SS) were analyzed using Kaplan-Meier methods and Cox proportional hazards ratios.Results: A total of 2,014 IBC, 1,268 LABC, 3,059 MBC, and 73,758 non-T4 breast cancer patient cases were identified. HER2+was associated with advanced tumor stage (P < 0.0001). IBC patient cases were more likely to be HER2+(40%) and less likely to be hormone receptor-positive (HmR+) (59%) compared with LABC (35% and 69%, respectively), MBC (35% and 74%), and non-T4 patient cases (22% and 82%). HmR+status was associated with improved OS and BC-SS for each breast cancer subtype after adjustment for clinically relevant factors. In multivariate analysis, HER2+(versus HER2-) status was associated with poor BC-SS for non-T4 patient cases (hazards ratio = 1.16, 95% confidence interval 1.05 to 1.28) and had a borderline significant association with improved BC-SS for IBC (hazards ratio = 0.82, 95% confidence interval = 0.68 to 0.99).Conclusions: Despite an association with advanced tumor stage, HER2+status is not an independent adverse prognostic factor for survival among IBC patient cases. © 2009 Zell et al.; licensee BioMed Central Ltd.

BACKGROUND: It has been reported that Asian ethnicity confers a survival benefit in colorectal cancer (CRC) compared with other ethnicities, but it is not known if this is limited to specific Asian subsets. In the current study, the authors attempted to determine differences using data from the large, population-based California Cancer Registry (CCR). METHODS: The authors conducted a case-only analysis of CCR data (1994–2003), including descriptive analysis of relevant clinical variables. Overall survival univariate analyses were conducted using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazards ratios (HR). RESULTS: The 61,494 incident cases of colon and 24,350 incident cases of rectal cancer analyzed included 1905 Chinese, 1162 Filipino, 414 Vietnamese, 391 Korean, 1091 Japanese, 148 Asian Indian, and 77,554 Caucasians. After adjustment for age, sex, grade, histology, site within the colon, stage of disease, insurance status, socioeconomic status (SES), and therapy, Filipino (colon: HR, 0.85; 95% confidence interval [95% CI], 0.76–0.95) (rectum: HR, 0.82; 95% CI, 0.71–0.94) and Chinese ethnicity (colon: HR, 0.90; 95% CI, 0.92–0.98) had significantly decreased risk of death compared with Caucasians. Sigmoid lesions were independently associated with improved survival among all cases (HR, 0.92; 95% CI, 0.88–0.95) (referent group were proximal and transverse lesions), and among Asian-only cases in separate analysis (HR, 0.78; 95% CI, 0.70–0.87). CONCLUSIONS: Although survival after CRC diagnosis is improved for Asians in general, significant survival differences are observed only in specific Asian subsets. Data from the current study suggest that survival among Asians is less affected by SES or treatment disparities, and may be because of biologic factors. Cancer 2009. © 2009 American Cancer Society.

Quantification of anthrax lethal toxin (LTx) neutralization activity (TNA) is pivotal in assessing protective antibody responses to anthrax vaccines and for evaluation of immunotherapies for anthrax. We have adapted and redesigned the TNA assay to establish a unifying, standardized, quantitative and validated technology platform for LTx neutralization in the J774A.1 murine cell line. Critical design features of this platform are 1) the application of a free-form or constrained 4 parameter logistic (4-PL) function to model neutralization responses within and between boundary limits of 100% cell survival and 95% cell lysis and 2) to exploit innovative assay curve recognition algorithms for interpretive endpoints. The assay was validated using human serum ED50 (dilution of serum effecting 50% neutralization) as the primary reportable value (RV). Intra-operator and intermediate precision, expressed as the coefficient of variation (%CV), were high at 10.5-15.5%CV and 13.5-14.5%CV respectively. TNA assay dilutional linearity was demonstrated for human sera using linear regression analysis of log(10) transformed data with slope=0.99, intercept=-0.03 and r(2)=0.985. Assay accuracy, inferred from the precision and linearity data and using a spike-recovery approach, was high with a percent error (%E) range of only 3.4-20.5%E. The lower limit of detection (LLOD) was ED50=12 and the lower limit of quantification (LLOQ) was ED50=36. The cell-based assay was robust, tolerating incubation temperatures from 35 to 39 degrees C, CO(2) concentrations from 3% to 7% and reporter substrate (MTT) concentrations of 2.5-7.5 mg/ml. Strict assay quality control parameters were met for up to 25 cell culture passages. The long term (50 month) assay stability, determined using human reference standards AVR414 and AVR801, indicated high precision, consistent accuracy and no detectable assay drift. A customized software program provided two additional assay metrics, Quantification Titer (QT) and Threshold Titer (TT), both of which demonstrate acceptable accuracy, precision and dilutional linearity. The TT was also used to establish the assay reactivity threshold (RT). The application of the assay to sera from humans, Rhesus macaques and rabbits was demonstrated separately and by aggregate dilutional linearity analysis of the ED50 (slope=0.98, intercept=0.003, r(2)=0.989). We propose this TNA assay format with a qualified standard reference serum and customized interpretive software as a unifying platform technology for determination of functional serologic responses to anthrax vaccines and for evaluation of anthrax immunotherapeutics.

e20012 Background: UV radiation has been considered the major environmental causative factor for melanoma. Our previous limited epidemiologic study suggested additional causative factors for early ...

3521 Background: Treatment of anal cancer (AC) relies on a multidisciplinary approach and highly-coordinated care. As such, health disparities may arise in vulnerable populations. Our aim was to an...

We used the San Diego/Orange County cancer registry to identify 64 cases of systemic non-Hodgkin's lymphoma (NHL) with AIDS who received highly active antiretroviral therapy (HAART) at the time of NHL diagnosis or thereafter and 64 NHL controls without AIDS, matched on age, sex, race, time of NHL diagnosis (1994-1995 and 1996-1999), and hospital type (academic, large community, and small community). We compared cases and controls by chi-squared tests and Kaplan-Meier methods. Thirty-three percent of cases had high grade histology versus 11% of controls (p < 0.01); 69% had baseline hemoglobin

Highly active antiretroviral therapy (HAART) became available in the US in 1996. Using the population-based cancer registry, we identified 233 patients with AIDS-related systemic NHL diagnosed in San Diego or Orange County in 1994–1999, of whom 137 were diagnosed 1996–1999. We performed Kaplan-Meier analyses to compare survival between patients who received HAART at NHL diagnosis or thereafter versus untreated patients and Cox proportional hazard models for adjusted survival. We used logistic regression to determine if concomitant HAART changed the probability of complete response to chemotherapy and the Mann–Whitney U-test to compare the median number of chemotherapy cycles between patients who received HAART during chemotherapy versus those who did not. Among patients diagnosed with NHL in 1996–1999, 40 (29%) were taking HAART at NHL diagnosis. The median survival was three months among patients who did not receive HAART versus 16 months among HAART-treated patients. HAART, chemotherapy, high performance status, and NHL stage

BACKGROUND AND AIMS: Colorectal cancer screening beginning at age 50 is recommended for all Americans considered at average risk for the development of colorectal cancer regardless of gender or race/ethnicity. We determined the influence of gender and race/ethnicity on the cost-effectiveness of recommended colorectal cancer screening regimens. METHODS: We determined age-specific colorectal cancer incidence rates; the proportion of left-sided cancers; and the proportion of localized cancers in Asian, black, Latino and white men and women using the California Cancer Registry. We incorporated these data and available data for life expectancy and colorectal cancer survival to model the cost-effectiveness of two 35-year colorectal cancer-screening interventions. RESULTS: Age-specific colorectal cancer incidence rates were highest in black men and lowest in Latino women. Screening beginning at age 50 was most cost-effective in black men and least cost-effective in Latino women (measured as dollars spent per year of life saved) using annual fecal occult blood testing combined with flexible sigmoidoscopy every five years and using colonoscopy every 10 years. The cost-effectiveness of a 35-year screening program in black men beginning at age 45 was similar to the cost-effectiveness of screening white men and black women beginning at age 50 and more cost-effective than screening nonblack women as well as Asian and Latino men beginning at age 50. CONCLUSIONS: Screening is most cost-effective in black men because of high age-specific colorectal cancer incidence rates. Initiation of colorectal cancer screening in this high-risk group prior to age 50 should be strongly considered.

Objectives. Some risk factors for cervical cancer in situ convey risk for malignancies of the cervix and other sites. We estimate risk of several malignancies following in situ cancer of the cervix for Hispanic Americans and non-Hispanic Whites. Methods. Using California Cancer Registry data (1988-1999) we identify 56,020 women with cervical cancer in situ and observe subsequent malignancies in that cohort, with over three million woman-months of follow-up, We focus on cancers of the reproductive system and cancers related to smoking. Risk estimates are standardized incidence ratios, accounting for age, time at risk, cancer type, and race/ethnicity. Results. There is elevated risk for invasive cervical cancer (SIR=4.1, 95% Cl: 3.5-4.7), which is significantly higher for Hispanics than for non-Hispanic Whites (SlRs = 5.2 and 3.2, respectively, X-2(l)=7.66, P=0.006). Excluding cervix, non-Hispanic Whites show elevated risk for a pool of reproductive cancers (SIR= 1.8, 95% Cl: 1.4-2.4). While both groups show elevated risk for a pool of smoking-related cancers, only non-Hispanic Whites show significant risk specifically for lung cancer (SIR= 1.7, 95% CI: 1.4-2.1). Non-Hispanic Whites show elevated risk for ovarian cancer (SIR = 1.8, 95% CI: 1.3-2.4). Ovarian cancer following in situ cervical cancer is disproportionately of borderline histology (G(2)(l)=7.43, P=0.006). Conclusions. These results have implications for public health planning for women, as well as better understanding of disparities in care or biologic paths to malignancies in women with in situ cancer of the cervix. (c) 2006 Elsevier Inc. All rights reserved.

Background: Our objective was to determine risks factors for late onset candidemia, independent of birth weight, in newborn infants. Methods: We performed a matched case-control study. Cases were identified through active, population-based surveillance for candidemia, conducted in Baltimore City and County during 1998-2000, and were defined as the incident isolation of any Candida species from the bloodstream of an infant 3 months old or younger. Four controls, matched by age, hospital, birth weight category, hospital stay and admission date, were selected for each case. Potential risk factors included clinical, demographic and maternal prenatal data. Results: Of the 35 cases, 19 (54%) infections were with Candida albicans, 9 (26%) were with Candida parapsilosis and 5 (14%) were with Candida glabrata. Cases had a median birth weight of 680 g (range, 430-3200 g); median gestational ages of cases and controls were 25 and 27 weeks, respectively. Compared with controls, cases had significant higher mortality (20% versus 4%; P = 0.004). No maternal factors were associated with increased risk of disease; cases were as likely as controls to be of black race. Multivariable conditional logistic regression analysis revealed that gestational age younger than 26 weeks [adjusted odds ratio, 6.5; 95% confidence interval (95% Cl), 1.3-32], vaginal delivery (adjusted odds ratio, 4.3; 95% CI 1.3-14.2) and abdominal surgery (adjusted odds ratio, 10.9; 95% CI 1.9-62) were independently associated with increased risk of candidemia. Conclusions: Independent of birth weight, infants born at

Carcinogenesis proceeds through a very long preclinical period. Our collective hope is that multiple opportunities exist for chemoprevention to arrest or reverse progression towards malignancy. In the hope of faster progress with fewer subjects and lower total cost, much effort is being expended on the search for reliable biomarkers to predict the likelihood of developing cancer and/or to signal the effectiveness of chemopreventive therapy. Considerable attention is paid to identifying those markers that can act as surrogate markers for cancer development, since favorable modulation of the surrogate end-point biomarker (SEBM) may demonstrate effectiveness of a putative preventive treatment. However, the complexity of the biology challenges our ability to measure the effectiveness of attempts to arrest or reverse carcinogenesis, other than through costly and time-consuming prospective trials with disease state as the endpoint. Despite much work, to date no prehistologic biological or molecular intermediate marker has been validated for sporadic cancers. Several factors accounting for the difficulties encountered in SEBM development are reviewed. Discussion is focused on the common thread of the complexity of the underlying biological changes in carcinogenesis limiting the effectiveness of any single biomarker. Additionally, the incidence of sporadic cancers is also low, further limiting the positive predictive value of any putative prognostic marker. Recent successes in development of chemopreventive agents show the concept is valid and worth pursuing, but the current strategies to develop biochemical and genetic markers to identify surrogate biomarkers is flawed, and need to be reassessed in light of the difficulties faced over the last 20 years.

Carcinogenesis proceeds through a very long preclinical period. Our collective hope is that multiple opportunities exist for chemoprevention to arrest or reverse progression towards malignancy. In the hope of faster progress with fewer subjects and lower total cost, much effort is being expended on the search for reliable biomarkers to predict the likelihood of developing cancer and/or to signal the effectiveness of chemopreventive therapy. Considerable attention is paid to identifying those markers that can act as surrogate markers for cancer development, since favorable modulation of the surrogate end point biomarker (SEBM) may demonstrate effectiveness of a putative preventive treatment. However, the complexity of the biology challenges our ability to measure the effectiveness of attempts to arrest or reverse carcinogenesis, other than through costly and time-consuming prospective trials with disease state as the endpoint. Despite much work, to date no prehistologic biological or molecular intermediate marker has been validated for sporadic cancers. Several factors accounting for the difficulties encountered in SEBM development are reviewed. Discussion is focused on the common thread of the complexity of the underlying biological changes in carcinogenesis limiting the effectiveness of any single biomarker. Additionally, the incidence of sporadic cancers is also low, further limiting the positive predictive value of any putative prognostic marker. Recent successes in development of chemopreventive agents show the concept is valid and worth pursuing, but the current strategies to develop biochemical and genetic markers to identify surrogate biomarkers is flawed, and need to be reassessed in light of the difficulties faced over the last 20 years.

Treating infections is one of the greatest successes in medicine, but it may be too easy to prescribe antibiotics. This report reviews U.S. outpatient antibiotic use in 2010.

Little is known about potential long-term health effects of bioterrorism-related Bacillus anthracis infection.To describe the relationship between anthrax infection and persistent somatic symptoms among adults surviving bioterrorism-related anthrax disease approximately 1 year after illness onset in 2001.Cross-sectional study of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical review-of-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records.Health complaints summarized by the body system affected and by symptom categories; psychological distress measured by the Revised 90-Item Symptom Checklist; and health-related quality-of-life indices by the Medical Outcomes Study 36-Item Short-Form Health Survey (version 2).The anthrax survivors reported symptoms affecting multiple body systems, significantly greater overall psychological distress (P.001), and significantly reduced health-related quality-of-life indices compared with US referent populations. Eight survivors (53%) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors (mean scores, 30 vs 41; P =.02). Available medical records could not explain the persisting health complaints.The anthrax survivors continued to report significant health problems and poor life adjustment 1 year after onset of bioterrorism-related anthrax disease.

Cancer chemoprevention is a rapidly evolving approach to reverse or inhibit carcinogenesis, and there is active interest in development of effective chemopreventive agents against head and neck cancers. The retinoids are archetypal chemopreventive agents for oral premalignant lesions. They have significant clinical effect, but widespread use is limited by significant clinical toxicity. The Bowman-Birk Inhibitor is one of several nontoxic compounds exhibiting both potent anticarcinogenic activity and minimal toxicity. The purposes of the study were to summarize the preclinical and clinical development of Bowman-Birk Inhibitor and a Bowman-Birk Inhibitor concentrate against oral premalignant lesions and to evaluate Neu immunohistochemical staining intensity for lesions and simultaneously obtained biopsy specimens of normal-appearing mucosa from the Phase IIa Bowman-Birk Inhibitor concentrate oral leukoplakia chemoprevention trial. Part I is a selected literature review. Part II is a retrospective analysis of pathological specimens prospectively obtained from the Phase IIa clinical trial of Bowman-Birk Inhibitor concentrate. Thirty-two sets of biopsy specimens from lesions and uninvolved oral mucosa before and after treatment with Bowman-Birk Inhibitor concentrate in doses ranging from 200 to 1066 chymotrypsin inhibitory units were examined in blinded fashion for Neu immunohistochemical staining intensity using the 3B-5 monoclonal antibody. Staining intensity scores among the lesion and control biopsy specimens before and after Bowman-Birk Inhibitor concentrate treatment were analyzed and compared with previously obtained values for serum Neu, oral mucosal cell Neu, protease activity, and clinical response to treatment. Mean Neu staining score was significantly higher in lesions compared with uninvolved mucosa (P

The issuance in 2002 of new guidelines recommending universal screening for group B Streptococcus (GBS), a leading cause of neonatal sepsis in the United States, has created a new opportunity to educate women of childbearing age to be active partners in prevention.To assess baseline levels of awareness about perinatal GBS, we analyzed responses to a question included in a health communications/social marketing survey in 1999 and 2002.Among the 2917 women under 50 who responded, 47% reported ever having heard of perinatal GBS. Among women pregnant at the time of the survey, awareness was 66%. Women with a high school education or less (OR = 0.60, 95% CI 0.50-0.73), household income25,000 US dollars (OR 0.65, 95% CI 0.54-0.79), or reporting black, Asian/Pacific Islander, or other race (ORs [95% CI] 0.70 [0.57-0.87], 0.61 [0.41-0.90], 0.41 [0.20-0.85], respectively) had lower awareness of perinatal GBS than other women. Women currently pregnant (OR 2.2, 95% CI 1.5-3.3) had higher awareness.Awareness of perinatal GBS is high among currently pregnant women, for whom this issue is most important. Efforts to raise awareness should be targeted to women from traditionally underserved populations, such as those who are of nonwhite race or who have lower educational attainment or household income.

Ovarian cancer is a life-threatening diagnosis which poses multiple challenges. The purpose of this study is to describe the quality of life (QOL) concerns and survivorship sequelae of long-term (>5 yr) early-stage ovarian cancer survivors accrued through the clinical cooperative Gynecologic Oncology Group. Forty-nine ovarian cancer survivors with a mean age at diagnosis of 55.9 yr (range 30–76) completed a telephone interview assessing QOL, psychosocial status, sexual functioning and late-effects of treatment. Results indicate that this disease-free early-stage sample enjoys a good QOL, with physical, emotional, and social well-being comparable to other survivors and same-aged noncancer cohorts. However, 20% of survivors indicated the presence of long-term treatment side effects, with a subset reporting problems related to abdominal and gynecologic symptoms, and neurotoxicity. Spiritual well-being was significantly positively associated with personal growth and mental health, and negatively associated with a declining health status. Lingering psychological survivorship sequelae included fear of follow-up diagnostic tests and fear of recurrence. Forty-three percent of respondents expressed that they would likely participate in a counseling program today to discuss psychosocial issues raised by having had ovarian cancer, and 56% stated that they would have attended a support program during the initial treatment if it had been offered. This information provides some insight into the complex survivorship relationships between quality of life, long-term physical and sexual sequelae, and factors of resilience and growth which appear to promote a sense of well-being as a result of the cancer experience. Copyright © 2002 John Wiley & Sons, Ltd.

Background & Aims: Colorectal cancer screening beginning at age 50 is recommended for all Americans considered at "average" risk for the development of colorectal cancer. Methods: We used 1988–1995 California Cancer Registry data to compare the cost-effectiveness of two 35-year colorectal cancer screening interventions among Asians, blacks, Latinos, and Whites. Results: Average annual age-specific colorectal cancer incidence rates were highest in blacks and lowest in Latinos. Screening beginning at age 50 was most cost-effective in blacks and least cost-effective in Latinos (measured as dollars spent per year of life saved), using annual fecal occult blood testing (FOBT) combined with flexible sigmoidoscopy every 5 years and using colonoscopy every 10 years. A 35-year screening program beginning in blacks at age 42, whites at age 44, or Asians at age 46 was more cost-effective than screening Latinos beginning at age 50. Conclusions: Colorectal cancer screening programs beginning at age 50, using either FOBT and flexible sigmoidoscopy or colonoscopy in each racial or ethnic group, are within the $40,000–$60,000 per year of life saved upper cost limit considered acceptable for preventive strategies. Screening is most cost-effective in blacks because of high age-specific colorectal cancer incidence rates. GASTROENTEROLOGY 2001;120:848-856

The relationship of modes of control and desire for control to psychosocial adjustment in women with breast cancer was examined. Fifty-eight women with stage I or stage II breast cancer were surveyed shortly after their diagnosis and again 4 and 8 months later. The authors hypothesized that a control profile in which individuals use a positive yielding (i.e., accepting) mode of control in conjunction with an assertive mode results in better adjustment than relying exclusively or primarily on an assertive mode. Results lend preliminary support to this hypothesis. At 8-month follow-up, those women who had a high desire for control and were low in positive yielding control showed the poorest adjustment, whereas those high in desire and the positive yielding mode showed the best psychosocial adjustment. The findings suggest that balanced use of active and yielding control efforts may lead to optimal psychosocial adjustment and quality of life in the face of life-threatening illnesses.

In women, breast cancer is the most frequent solid tumor and the second leading cause of cancer death. Differences in survival of breast cancer have been noted among racial/ethnic groups, but the reasons are unclear. This report presents the characteristics and the survival experience of four racial/ethnic groups and evaluates the effects of stage, age, histology, and treatment on survival time. The distributions of prognostic factors and treatment among racial/ethnic groups are compared using female breast cancer patients from two population-based registries in Southern California. The main end points are observed survival time and survival by cause of death. The Cox model is used to estimate the relative risk of death in three minority groups compared with non-Hispanic whites, while controlling for several covariates. Breast cancer cases included in this study were 10,937 non-Hispanic whites, 185 blacks, 875 Hispanics, and 412 Asians. The median follow-up period was 76 months (range: 48-132). The median age at diagnosis was 64 years among non-Hispanic whites, 55 years among Hispanics (p = 0.001), 52 years among blacks (p = 0.001), and 50 years among Asians (p = 0. 001). There was more localized disease among non-Hispanic whites (61. 4%) than among blacks (50.8%) and Hispanics (52.2%), but not compared to Asians (59.7%). After controlling for stage, age, histology, treatment, and registry, overall survival significantly differed between non-Hispanic whites and blacks [relative risk (RR) = 2.27, 95% confidence interval (95% CI) 1.82-2.84) and between non-Hispanic whites and Hispanics (RR = 1.18, 95% CI 1.04-1.34). The same results were found for breast cancer death in blacks (RR = 2.32, 95% CI 1.76-3.07) and Hispanics (RR = 1.28, 95% CI 1.10-1.50). We found no difference between Asians and non-Hispanic whites in overall and cancer-related survival. These results show that stage of disease, age at diagnosis, histologic features and treatment for breast cancer differed among racial/ethnic groups. Moreover, black women, in particular, and Hispanic women with breast cancer had a higher risk of death compared to non-Hispanic white women, even after controlling for prognostic factors. These findings underline the necessity of improved screening and access to appropriate treatment among minority women for breast cancer.