Inequity of upper gastrointestinal cancer distribution and survival with socioeconomic deprivation: a population-based study.

BACKGROUND: It is postulated that patients with upper gastrointestinal cancers from affluent classes have better survival outcomes than those from deprived backgrounds. We aimed to analyze the incidence, mortality, and survival trends of esophageal, gastric, and pancreatic cancers in West Midlands, England, from 1986 to 2000 in terms of socioeconomic deprivation. METHODS: A well-validated demographic score, the Townsend Band, was employed as a measure of socioeconomic status. Data were collated from a cancer registry database; the individuals were allocated to 1 of 5 Townsend bands by using the postcodes at diagnosis. Relative survival rates were calculated by using stratified actuarial life tables, regression trend analysis at 1 and 5 years was performed, and the P value was derived from a t test statistic. RESULTS: An increase in esophageal cancer incidence was more marked in the affluent categories (127%), compared with the deprived categories (57%). Gastric cancer incidence fell preferentially by 31% and 47% in the most-deprived men and women, respectively, but remained relatively unchanged in the affluent groups. A marginal overall decrease in pancreatic cancer incidence masked preferential increases in the most-affluent men (39%) and women (41%). Small increases in 1- and 5-year survival were noted in affluent subgroups, with the 1-year survival advantage for esophageal cancer achieving significant levels in the most-affluent categories (P = .05). CONCLUSIONS: The esophageal cancer incidence increased preferentially in the affluent groups but with a marginally better survival rate. The gastric cancer incidence decreased noticeably in the most-deprived groups, suggesting that improvements in hygiene with consequent reduction in Helicobacter pylori primarily could be responsible. Pancreatic cancer trends were unrelated to social deprivation and warrant further studies.

Trends in prostate cancer incidence and survival in various socioeconomic classes: a population-based study.

OBJECTIVES: Prostate cancer is currently the commonest cancer in men of all ages in UK, but robust demographic data of its distribution in various socioeconomic classes is lacking. We aimed to analyze its incidence, mortality and survival trends in West Midlands, England, from 1986 to 2000 in terms of socioeconomic deprivation. METHODS: Data were collated from the regional cancer registry database and a well-validated demographic score, the Townsend band, was employed as an indicator of social deprivation, including four variables as proxy indicators of socioeconomic status. Individual cases were allocated to one of five deprivation categories using postcode at diagnosis. Regression trend analysis at 1 and 5 years was performed and a P-value derived from the t-test statistic. RESULTS: In the mid-1980s, the incidence rate ratio in affluent:deprived classes was 0.9, with age-standardized rates of 35.23 and 39.53 per 100 000 people. This ratio increased to 1.5 by 2000 with age-standardized rates of 95.98 and 63.13, respectively (172% increase in affluent compared with 60% in deprived). The affluent groups had a 7 and 13% survival advantage at 1 and 5 years; the survival advantage at 1 year was statistically significant (P=0.03). CONCLUSIONS: The preferential changes in incidence and survival in the affluent social classes are likely to be due to heightened awareness, resulting in increased prostate-specific antigen testing, which captures early and relatively slow-growing tumors with a better overall prognosis. If these bipolar trends are allowed to persist, then the gap between the affluent and deprived will continue to widen.

Is a digital rectal examination necessary in the diagnosis and clinical staging of early prostate cancer?

OBJECTIVE: To assess the role of a digital rectal examination (DRE) in the clinical diagnosis of prostate cancer and in predicting the pathological stage, as the diagnosis of early prostate cancer usually comprises prostate-specific antigen (PSA) testing, a DRE and transrectal ultrasonography (TRUS)-guided biopsies. PATIENTS AND METHODS: Over the 4 years between 2000 and 2004, 408 consecutive patients (mean age 63.8 years) referred with age-specific PSA levels of 2.5-10.0 ng/mL and who had a TRUS-guided 12-core prostate biopsy were included in the study. They had a DRE by either of two experienced consultant urologists. The results of the DRE and core biopsy histology were compared with the histology and the radical prostatectomy specimen in a subset (82 men) of the study population. RESULTS: Cancer was detected on biopsy in 152 patients; of the 196 with an abnormal DRE, 47% had cancer on biopsy. In the patients with a normal DRE, 59 cancers were detected. Men with cancer were older and had a higher median PSA level. There was no correlation between the DRE and biopsy findings, and none between an abnormal DRE and histological diagnosis of cancer. Of the patients who had a radical prostatectomy, 38% had a normal DRE. CONCLUSION: There was no correlation between the DRE, biopsy findings and pathological staging. The DRE did not contribute to managing patients with prostate cancer, but this does not mean that there is no longer a place for the DRE in assessing the urological patient. If patients are appropriately counselled before PSA testing, a DRE may not be essential for patients with a PSA level of 2.5-10 ng/mL.

A rare case of breast carcinoma co-existing with axillary mantle cell lymphoma.

ABSTRACT : BACKGROUND : Mantle cell lymphoma (MCL) is a rare variety of non-Hodgkin's lymphoma which originates from CD5+ B-cell population in the mantle zones of lymphoid follicles. Coexistence of such tumours in the axillary lymph nodes with invasive breast cancers without prior history of adjuvant chemotherapy or radiotherapy has not been previously reported in literature. CASE REPORT : We report a rare case of breast cancer co-existing with stage I mantle cell lymphoma of the ipsilateral axillary lymph node detected fortuitously by population screening. CONCLUSION : Though some studies have tried to prove breast carcinomas and lymphomas to share a common molecular or viral link, more research needs to be done to establish whether such a link truly exists.