ABSTRACT
BACKGROUND: Detection and estimation of trends in cancer incidence rates are commonly achieved by fitting standardized rates to a joinpoint log-linear regression. The efficiency of this approach is inadequate when applied to a relatively low levels of incidence. We compared that approach with the Cuscore test with respect to detecting a log-linear increasing trend of chronic myelomonocytic leukemia (CMML) in datasets simulated to match a province of about 700,000 inhabitants. METHODS: For better efficiency, we replaced the standardized rate as the dependent variable with a continuous statistic that reflects the inverse of the standardized incidence ratio (SIR). Both procedures were applied to datasets simulated to match published results in the Girona Province of Spain. We also present the use of the q-interval in displaying the temporal pattern of the events. This approach is demonstrated by analyses of CMML diagnoses in Girona County (1994-2008). RESULTS: The Cuscore was clearly more efficient than regression in detecting the simulated trend. The relative efficiency of the Cuscore is likely to be maintained in even higher levels of incidence. The use of graphical displays in providing clues regarding interpretation of the results is demonstrated. CONCLUSIONS: The Cuscore test coupled with visual inspection of the temporal pattern of the events seems to be more efficient than regression analysis in detecting and interpreting data suspected to be at elevated risk. A confirmatory analysis is expected to weed out 75% of the superfluous significant results.
Subject(s)
Neoplasms/epidemiology , Aged , Aged, 80 and over , Female , Humans , Incidence , Linear Models , Male , Spain/epidemiologyABSTRACT
A 27-year-old female white-collar worker was diagnosed in 1998 with mesothelioma eight and one-half years following first exposure as a bystander to debris in a site in which asbestos-containing building materials were being dismantled and rebuilding work took place. Prodromal back pain had been present for a year and a half. She underwent extrapleural pneumectomy and received an intrapleural infusion of cisplatin post-operatively. Exposure to asbestos was verified by contemporary reports and lung biopsy, which demonstrated asbestos bodies and microscopic interstitial fibrosis -conforming evidence for asbestosis. The patient is alive and well 12 years after diagnosis and 14 years after onset of symptoms. The combination of an extremely short latency period and long survival following occupational exposure to asbestos dust is unique.
Subject(s)
Asbestos/adverse effects , Asbestosis/etiology , Construction Materials/adverse effects , Mesothelioma/chemically induced , Pleural Neoplasms/chemically induced , Adult , Antineoplastic Agents/administration & dosage , Asbestosis/diagnosis , Asbestosis/therapy , Biopsy , Chemotherapy, Adjuvant , Cisplatin/administration & dosage , Female , Humans , Infusions, Parenteral , Mesothelioma/diagnosis , Mesothelioma/therapy , Occupational Exposure , Pleural Neoplasms/diagnosis , Pleural Neoplasms/therapy , Pneumonectomy , Time Factors , Treatment OutcomeABSTRACT
A 61-year-old artist in Israel had been painting for 30 years in his home studio. He had been healthy until he reached the age of 59.5 years, at which time he began complaining of weakness and paresthesia in both hands and legs. He also complained that he had difficulty concentrating, and his memory was impaired. His work was unusual in that he painted large posters (i.e., 2 x 3 m) with different mixtures of organic solvents, including toluene, xylene, benzene, methyl ethyl ketone, toluene diisocyanate, acetone, and thinner. He did not use any protective gloves and did not wear a mask. He was evaluated with several methods and was diagnosed as having peripheral and central neuropathy, including ototoxic hearing loss as a result of long exposures to organic solvents. The authors were unable to find any similar case report in the literature.
