Survival experience in the Breast Cancer Detection Demonstration Project.

Very high survival rates have been observed in four through 11 years of follow-up in 4,240 women with a histologically confirmed diagnosis of breast cancer in the Breast Cancer Detection Demonstration Project (BCDDP). The relative five, eight, and 10-year survival rates were 88, 83, and 79 percent, respectively. Allowances were made for lead-time bias among cancers detected through screening, and the validity of the findings was supported by internal analyses, which showed that length-time bias was of little, if any, importance, and that any possible "overdiagnosis" of cancer cases was also of small relevance. In view of current interest in the value of screening women before age 50, intensive analyses were made comparing the BCDDP data for women in their 40s with women in their 50s. In terms of kinds of breast cancers found, modality of finding them, and survival rates once they have been found, the parallel results for the two groups show that screening was virtually as effective in the younger as in the older women. Some authorities are of the opinion that the benefits of mammography after age 50 are well documented, but at younger ages the evidence is still inconclusive. The findings in this study show there is no doubt of the very successful results of screening for breast cancer with mammography in younger as well as older women. In comparing relative five-year and eight-year survival rates for women with invasive breast cancers detected through screening in the BCDDP, with those for cases diagnosed in the National Cancer Institute's Surveillance, Epidemiology and End Results (NCI SEER) program from 1977 to 1982, it is seen that for individual subcategories by tumor size and nodal class, the survival rates are about the same. However, for overall invasive cancers, the five-year and eight-year survival rates were 87 and 81 percent, respectively, for the BCDDP compared with 74 and 65 percent for SEER. Thus the substantial gains in survival followed the large shift toward a high proportion of cancers being diagnosed and treated in more favorable stages through the screening accomplishments. With respect to the relative case fatality rates, the complements of the relative survival rates, the eight-year rate of 19 percent for the BCDDP versus that of 35 percent for SEER connotes 46 percent fewer women dying in the BCDDP group.

Mortality experience of amosite asbestos factory workers: dose-response relationships 5 to 40 years after onset of short-term work exposure.

A cohort of 820 men in a Paterson, New Jersey, amosite asbestos factory which began work during 1941-1945 was observed from 5 to 40 years after start of work. Most of the cohort had limited duration of work experience (days, weeks, months), though some men worked for several years until the factory closed in 1954. With white males of New Jersey as the control population, Standardized Mortality Ratios (SMRs) of 500 are evident for the cohort for lung cancer and for noninfectious pulmonary diseases (including asbestosis), while being almost 300 for total cancer and about 170 for all causes of death. A statistically significant SMR of almost 200 is seen for colon-rectum cancer. Mesothelioma incidence initially shows a strong relationship with advancing time since onset of exposure and then tails off. The main concern of the study is with dose-response patterns. Response is measured by the mortality for relevant causes of death, while the direct asbestos dosage was measured in two ways. One way was the length of time worked in the factory and the other was the individual's accumulated fiber exposure, calculated by multiplying the aforementioned length of time worked by the estimated fiber exposures associated with the particular job that the worker had in the factory. Whichever measure of dosage is used, it was found that, in general, the lower the dose, the longer it took for adverse mortality to become evident and, also, the smaller the magnitude of that adverse mortality.

Clinical findings among asbestos workers in U.S.: influence of cigarette smoking.

All members of a large union were invited to participate in a study of potentially adverse effects of asbestos exposure. Clinical findings among 1,117 workers (90% of those eligible for examination) are presented in this study. Cough was much less common among those without a history of cigarette smoking, although duration from onset of employment did not appreciably affect the prevalence of cough among the smokers. Rhonchi present among nonsmokers were limited in extent, but were marked and diffuse among cigarette smokers. Although dyspnea was as prevalent among nonsmokers as in smokers forty years and more after onset of exposure, it was relatively uncommon and found only among smokers when examined shortly after onset of exposure. Cigarette smoking had less influence on the prevalence of râles among asbestos workers; both smokers and nonsmokers showed this finding when examined 30 years and more after onset of asbestos exposure. Analysis of powerhouse work experience and mask use as possible confounders indicated no difference in prevalence of these characteristics between the smokers and nonsmokers.

Asbestosis: interstitial pulmonary fibrosis and pleural fibrosis in a cohort of asbestos insulation workers: influence of cigarette smoking.

A cohort of 1,117 asbestos insulation workers was established in 1963 and has been prospectively followed since then. Chest X-ray abnormalities detected at the initial medical examination, and interpreted according to the International Labour Office Classification of Radiographs of Pneumoconioses are reported in this paper. The prevalence of all radiographic abnormalities (pleural and pulmonary) increased with duration from onset of asbestos exposure. A positive smoking history was associated with a significantly higher prevalence of small irregular opacities indicating interstitial pulmonary fibrosis. Such an association was not found for pleural fibrosis. The possible mechanisms which underlie the effect of smoking on asbestos-induced interstitial fibrosis seem to be of much less importance in the development of pleural fibrosis. Progression of radiographic changes over the 20-year interval 1963-1983 will be separately reported as will the predictive significance of these changes.

Probabilities of eventually developing or dying of cancer--United States, 1985.

The usual measures of the magnitude of the cancer problem are annual incidence and mortality data. We present another measure of the magnitude of the cancer problem. We computed the probabilities at birth and at various ages of developing or dying of the disease within 10 years, 20 years, or total lifetime and show the trends that have occurred in these data since 1975. These probabilities were computed for males and females and among whites and blacks for 1975 and 1980, and projected to 1985. The data indicate a continuing, albeit modest, increase in the probabilities of eventually developing cancer in each of the four sex-race groups, both excluding and including carcinoma in situ. White males now show the highest probability at birth of eventually developing cancer, and black females, the lowest, with the figures for the other two groups being intermediate. Larger increases were seen for males between 1980 and 1985 (more than three percent) than for females (two percent or less). A child born in the US in 1985 has more than one in three chances of eventually developing invasive cancer (exclusive of epidermoid skin cancer). By site, for males the largest probabilities and the largest increases in the probabilities are for eventually developing lung and prostate cancer. For women, the largest eventual probabilities are for breast cancer, almost one in 10 for white females and one in 14 for black females. The largest increases are seen for lung cancer and cancer of the colon-rectum. The probability of eventually dying of cancer is increasing among the four sex-race groups and is now greater for males of both races than for their female counterparts. For males born in 1985, the chances of eventual death from cancer are almost one in four, and for females, almost one in five. With the long-term, downward trends in terms of other causes of death--most specifically, decreases in mortality from cardiovascular diseases--the effect on the population at large is greater longevity. This situation, in turn, leaves more people longer time to be exposed to cancer risks. Thus, while the probabilities of developing or dying of cancer are seen to increase, the increases should be viewed in light of the increasing numbers of people available for such an occurrence.(ABSTRACT TRUNCATED AT 400 WORDS)