Search

Background: Malignancy risks in patients with neurofibromatosis 1 (NFl) are increased, but those occurring outside of the nervous system have not been clearly defined. Aim: To evaluate the risk of breast cancer in women with NFl in a population-based study. Methods: The risk of breast cancer in a cohort of 304 women with NFl aged ≥20 years was assessed and compared with population risks over the period 1975-2005 using a person-years-at-risk analysis. Results: There were 14 cases of breast cancers in the follow-up period, yielding a standardised incidence ratio (SIR) of 3.5 (95% CI 1 .9 to 5.9). However, six breast cancers occurred in women in their 40s, and the SIR of breast cancer in women aged <50 years was 4.9 (95% CI 2.4 to 8.8). Interpretation: Women with NFl aged <50 years have a fivefold risk of breast cancer, are in the moderate risk category and should be considered for mammography from 40 years of age. [ABSTRACT FROM AUTHOR]

Presents an abstract of the article "The Trouble with Phenocopies: Are Those Testing Negative For a Family BRCA 1/2 Mutation Really at Popular Risk?" by Gareth Evans, A. Smith, A. Moran, M.C. Boyd, M. Bulman, A. Shenton, l. Smith, R. Iddenden, E. Woodward, F. Lalloo.

A deficit in colorectal cancer survival in Denmark and in the UK compared to Sweden, Norway and Finland was found in the EUROCARE studies. We set out to explore if these differences still exist. Patients diagnosed with colorectal cancer as their first invasive cancer at age 15-89 in the period 1994-2000 were identified using data from 11 cancer registries in the UK and from four Nordic countries. Five-year relative period survival using deaths in 1999-2000 following cancers diagnosed in 1994-2000 was analysed with excess mortality risk modelling. Follow-up time since diagnosis with age as an effect-modifier in the first half year was the most important factor with the highest excess risk of death immediately after diagnosis and with higher age and decreasing with length of follow-up. Variations between countries were bigger in the first half year following diagnosis than in the interval 0.5-5 years with about 30% higher risk in UK and Denmark. The differences between countries are still substantial and the order has not changed, even if the five year relative survival has improved since the EUROCARE studies. Patient management, diagnostics, and comorbidity likely explain the excess deaths in UK and Denmark during the first 6 months. The effect of stage and quality of management and treatment should be examined in population based studies with detailed patient information. Use of more detailed age-intervals than conventionally applied in survival studies proved to be important in statistical modelling and is recommended for future studies., ((c) 2007 Wiley-Liss, Inc.)

Introduction: The impact of cancer on people's working lives is an increasingly important concern, yet, little is known regarding return to work after cancer in England. The rate of cancer patients who returned to paid employment within 18 months of diagnosis, and explored associations with demographic, clinical and work perception in one English region was investigated., Materials and Methods: A postal survey of all cancer patients registered in North West England from June 2002 through December 2002. Participants were between the ages 18-55 with a primary diagnosis of cancer, in paid employment at the time of diagnosis and being judged by their General Practitioners as suitable for return to work., Results: Two hundred sixty-seven eligible patients returned a completed consent form and questionnaire, a response rate of 50%. The median age was 48 years. The majority of respondents (48%) were female with breast cancer, followed by colorectal (14%), prostate (9%) and lung cancers (6%). 82% of respondents returned to work. Treatment modality (absence of surgery) and the length of sick-leave were the only significant factors related to return to work (Odds Ratio 0.28 95% CI 0.08-0.94; Odds Ratio 1.68 95% CI .1.23-2.28). The median length of sickness absence was less than 6 months, longer in the most economically deprived quintile. One fifth of those who returned to work reported deterioration in job satisfaction and career prospects., Conclusions: While a high proportion of respondents managed to return to their place of work 20% were not able to do so. The duration of sick leave absence was associated with more difficulties in returning to work. Despite the fact that males were more likely than females to take no sick leave, they were more likely to take longer periods of absence when they did (18 months and over). In addition, the length of sick leave was greatest in the most economically deprived group, and in those survivors of cancer diagnosis and treatment who did not receive surgery.

Background: Tirilazad mesylate is neuroprotective in experimental models of ischaemic stroke suggesting it might be of benefit clinically., Objectives: To assess whether tirilazad mesylate is safe and effective at improving outcome in patients with acute ischaemic stroke., Search Strategy: Trials of tirilazad were identified from searches of the Cochrane Stroke Group Specialised Trials Register (last searched: May 2001) and the Cochrane Controlled Trials Register (CENTRAL/CCTR). In addition, we contacted the Pharmacia & Upjohn company, the manufacturer of tirilazad, to identify unpublished studies and further information., Selection Criteria: Truly and quasi-randomised unconfounded placebo or open controlled trials of tirilazad administered within 24 hours onset of suspected or proven acute ischaemic stroke., Data Collection and Analysis: Data relating to early and end-of-trial case fatality, disability (Barthel Index and Glasgow Outcome Scale), phlebitis, and QTc were extracted by treatment group from published data and company reports., Main Results: Six trials (four published, two unpublished) assessing tirilazad in 1757 patients with presumed acute ischaemic stroke were identified; all were double-blind and placebo-controlled in design. Tirilazad did not alter early case fatality (odds ratio, OR 1.11, 95% confidence intervals, 95% CI 0.79 to 1.56) or end-of-trial case fatality (OR 1.12, 95% CI 0.88 to 1.44). Tirilazad increased the odds of being dead or disabled by about one fifth, though the result was only just statistically significant; the odds ratios were similar whether the expanded Barthel Index or Glasgow Outcome Scale were used to assess outcome (OR 1.23, 95% CI 1.01 to 1.51; OR 1.23, 95% CI 1.01 to 1.50 respectively). Tirilazad significantly increased the rate of infusion site phlebitis (OR 2.81, 95% CI 2.14 to 3.69). Functional outcome (EBI) was significantly worse in prespecified subgroups of patients: females (OR 1.46, 95% CI 1.08 to 1.98) and subjects receiving low dose tirilazad (OR 1.31, 95% CI 1.03 to 1.67); a non-significant worse outcome was also seen in patients with mild-moderate stroke (OR 1.40, 95% CI 0.99 to 1.98)., Reviewer's Conclusions: Tirilazad mesylate increased the combined end-point of 'death or disability' by about one-fifth, but did not alter case fatality, when given to patients with acute ischaemic stroke. Although further trials of tirilazad are now not warranted, analysis of individual patient data from the trials may help elucidate why tirilazad appears to worsen outcome in acute ischaemic stroke.

Background and Purpose: Hypertension is a common medical complication in acute stroke and is associated with a poor outcome. However, no large trials have assessed the effect of lowering blood pressure (BP) on outcome, and it remains unclear how BP should be managed in acute stroke. We assessed, in a double-blind randomised controlled trial, whether the nitric oxide (NO) donor glyceryl trinitrate (GTN, a known systemic and cerebral vasodilator), would lower BP and alter platelet function., Methods: Thirty-seven patients with recent (< 5 days) ischaemic or haemorrhagic stroke were randomised by minimisation to 12 days of daily treatment with transdermal GTN or matching placebo patches. Twenty-four-hour ambulatory BP was measured before and during GTN treatment at days 0, 1 and 8. Platelet aggregation and expression of adhesion molecules were assessed at the same time points. Functional outcome (Rankin scale) and case fatality were assessed at 3 months. Analysis was by intention-to-treat., Results: GTN significantly lowered BP by 13.0/5.2 mm Hg at day 1 and 9.3/5.0 mm Hg at day 8. The lesser reduction at day 8 than day 1 suggests that tolerance to GTN was developing. Non-significant falls of 0.9/0.6 and 3.8/0.0 mm Hg occurred at days 1 and 8, respectively, in the placebo group. GTN had no effect on heart rate, or platelet aggregation or expression of platelet adhesion molecules, including glycoproteins Ia, Ib, IIIa and P-selectin. Additionally, GTN did not alter case fatality or dependency, although the study was not powered for these outcomes., Conclusions: Transdermal GTN, an NO donor, lowered BP by 5-8%, a clinically significant and relevant, but not excessive, degree in patients with acute stroke. However, GTN had no effect on platelet aggregation or expression of adhesion molecules. Since NO donors increase cerebral blood flow in patients with acute ischaemic stroke, GTN may be an appropriate drug for testing the effect of lowering BP on functional outcome., (Copyright 2001 S. Karger AG, Basel)