Predictors for the symptomatic prostate cancer patient's delays in seeking care.

AIM: This study aims to determine the predictors for the symptomatic prostate cancer patient's delays in seeking care. METHODS: We followed a cohort of 931 men with prostate cancer from Stockholm County (Sweden) asking about socio-demographic and information-level characteristics as well as the length of delay in seeking care. RESULTS: Of the 511 patients who returned a completed questionnaire, 219 (43%) reported having clinical symptoms before prostate cancer was diagnosed. Of all men with clinical symptoms, self-employed men were more likely to make an early first contact with the health-care system than pensioners or men with other employment (relative risk (RR), 3.9; 95% confidence interval (CI), 1.4-11.0). Men who had obtained moderate or much information from the internet about prostate cancer were more likely to have made an early first contact with the health-care system (RR, 2.2; 95% CI, 1.3-3.9). Men who had obtained moderate or much information from health-care staff (RR, 1.4; 95% CI, 1.0-1.6), or from any doctor (RR, 1.4; 95% CI, 1.0-1.8) or from family members/acquaintances (RR, 1.3; 95% CI, 1.0-1.9) had an early first visit to the health-care system. Men who were 70 to 80 years old started treatment earlier than men who were 50 to 69 years old (RR, 2.3; 95% CI, 1.4-3.6). CONCLUSIONS: The patients' level of information about prostate cancer obtained from the internet and other sources such as the health-care system, doctors or family members/acquaintances coupled with their employment status were influential in leading to early first contact and first visit to the health-care system. Older patients started treatment earlier than younger patients.

Economic conditions and marriage quality of men with prostate cancer.

OBJECTIVE: To explore the predictors of the quality of marriage of men with prostate cancer, as being diagnosed with prostate cancer affects the quality of life of the man and his partner, and while some aspects are known about the impact of the disease and its treatments on the man's quality of life, less is known about the marriage quality (MQ) in this new situation. PATIENTS AND METHODS: We followed 591 men from Stockholm County (Sweden) who had been diagnosed with prostate cancer in 1999, and who were 50-80-years old and alive on 1 October 2002. The men completed a questionnaire asking about their MQ, and several other sociodemographic, medical and economic characteristics. RESULTS: Of 426 men who provided information and who had a spouse or partner, 168 (39.4%) reported having a lower MQ due to their disease. Increased expenditure (46.2% vs 30.9%; relative risk, 1.5; 95% confidence interval, 1.1-2.0) and decreased income (55.4% vs 36.5%; 1.5, 1.1-2.0) as a consequence of prostate cancer reduced their MQ. Patients who had erectile dysfunction had a lower MQ (46.3% vs 11.8%; 3.9; 2.0-7.6). There was also a lower MQ in men who were depressed or had urinary leakage as a consequence of prostate cancer. Younger men (50-69 years old) with prostate cancer had a lower MQ than older men (70-80 years; 51.9% vs 33.1%; 1.6; 1.2-2.0). CONCLUSIONS: Men whose economic situation is worsened by prostate cancer reported having a reduced MQ. There was also such an effect for men with erectile dysfunction, urinary leakage and depression, and among men diagnosed with prostate cancer when young.

Is it reporting bias doubled the risk of prostate cancer in vasectomised men in Mumbai, India?

BACKGROUND: Vasectomy is a common method of family planning in India and worldwide. The objective of the present study was to assess the association of vasectomy with prostate cancer in a low risk population of a developing country. A population based case control study was conducted in Mumbai, India, for this purpose. METHODS: Included in this study were microscopically proved cases of prostate cancer diagnosed during 1998 to 2000 and registered by Bombay Population Based Cancer Registry (n=594). The controls were healthy men belonging to the resident general population of Mumbai, India. Two controls for each case matched by age and place of residence were selected as the comparison group. Data on vasectomy and potential confounding factors were obtained by structured face to face interviews. After exclusions, 390 cases and 780 controls were available for final analysis and confounding was controlled by multiple logistic regression. RESULTS: Overall 14.9% of cases and 10.0% of controls had undergone vasectomy. Compared with no vasectomy the OR with ever having undergone vasectomy was 1.9 (95% CI: 1.3-2.9), after controlling for age and other possible confounding factors. The risk for those who had had a vasectomy before the age of 45 years was 2.1 fold (95% CI: 1.2-3.9) and for those who underwent the procedure at a later age was 1.8 fold (95% CI: 1.1-2.9). The linear trend for an increase in risk with a decrease in age at vasectomy was statistically significant (p for trend = 0.01). The risk for those who completed 25 years or more time since undergoing vasectomy was 3.8 fold (95% CI: 1.9-7.6) and for those who completed less than 25 years it was 1.2 fold (95% CI: 0.7-2.1). The linear trend for an increase in risk with an increase in time since vasectomy was highly significant (p for trend = 0.001). CONCLUSION: There are major public health and birth control implications on vasectomy increases the risk for prostate cancer. It is likely, however, that biases identified in this study result in high estimates of risk and the true risk due to vasectomy is substantially less than the estimated one. Due to the several limitations and possibilities for reporting biases in this study, the evidence for the estimates of the higher odds ratio for prostate cancer in vasectomised men may not be a strong one. In view of the importance of vasectomy for fertility control, further studies with good design and conduct (the information on vasectomy need to be collected with better reliability) are required to clarify the issue of vasectomy associations with prostate cancer.

A low fat diet rich in fruits and vegetables may reduce the risk of developing prostate cancer.

BACKGROUND: Diet has been implicated in prostate cancer risk and there is evidence of risk reduction with a healthy diet. The objective of this population-based case control study was to examine whether a low fat diet rich in fruits and vegetables can reduce the risk of developing prostate cancer in Mumbai, India. METHODS: Included in this study were microscopically proved cases of prostate cancer diagnosed during 1998 to 2000 and registered by Bombay Population Based Cancer Registry (n=594). The controls were healthy men belonging to the resident general population of Mumbai, India. Two controls for each case matched by age and place of residence were selected as the comparison group. Data on oil/fat consumption, fruits and vegetable consumption and other probable confounding factors were obtained by structured face-to-face interview. After exclusions, 390 cases and 780 controls were available for final analysis and confounding was controlled by multiple logistic regression. RESULTS: 58.7% of the control group consumed more than 3 kg of fruits and vegetables per week compared to 52.1% of the case group. Controlling for age and probable confounding factors, a statistically significant protective effect for prostate cancer was observed for those who consumed fruits and vegetables 2 to 3 kg (OR 0.5, 95%CI 0.3-0.8) and more than 3 kg (OR 0.4, 95% CI 0.3-0.6) per week compared to those who consumed less than 2 kg per week. The linear trend for the protective effect was highly significant with increase in the consumption of fruits and vegetables (p = 0.001). Even though not statistically significant, oil/fat consumption showed an elevated risk (OR 1.7, 95%CI 0.9-3.3) for those who consumed more than 2 kg of oil/fat per month compared to those who consumed less than 1 kg. CONCLUSION: The findings from this study support the hypothesis that a low fat diet rich in fruits and vegetables may reduce the risk of prostate cancer.

Cumulative risk and trends in prostate cancer incidence in Mumbai, India.

BACKGROUND: Information relating to cancer incidence trends in a community forms the scientific basis for the planning and organization of prevention, diagnosis and treatment of cancer. We here estimated the cumulative risk and trends in incidence of prostate cancer in Mumbai, India, using data collected by the Bombay Population-based Cancer Registry from the year 1986 to 2000. METHODS: During the 15 year period, a total of 2864 prostate cancer cases (4.7% of all male cancers and 2.4% of all cancers) were registered by the Bombay Population-based Cancer Registry. For evaluation of the trend, we applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage changes were also computed for the evaluation. Cumulative incidence rates percentages were calculated by adding up the age specific incidence rates at single ages and then expressed as a percentage. RESULTS: Analysis of the trends in age-adjusted incidence rates of prostate cancer during the period 1986 to 2000 showed no statistically significant increase or decrease and the rates proved stable across the various age groups (00-49, 50-69 and 70+) also. The probability estimates indicated that one out of every 59 men will contract a prostate cancer at some time in his whole life and 99% of the chance is after he reaches the age of 50. CONCLUSION: The stability in age adjusted-incidence rates indicates that there are no changes in the etiological factors for prostate cancer in Mumbai, India. These findings may be of general interest because changes in diagnostic practices are confounded in the time trends of prostate cancer change in many western countries preventing inferences on the changes in risk.

Oral cancers in Mumbai, India: a fifteen years perspective with respect to incidence trend and cumulative risk.

OBJECTIVE: We estimated the time trends in the incidence and the risk of developing an oral cancer in Mumbai, Indian population using the data collected by the Bombay Population Based Cancer Registry during the 15 year period from 1986 to 2000. METHODS: A total of 9,670 oral cancers (8.2% of all neoplasms) were registered, of which 6577 were in males and 3093 in females (10.7% and 5.4% of the respective totals for the two genders). For evaluation of the trend, we applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage changes were also computed for the incidence rates to evaluate the time trend. RESULTS: In males, a statistically significant decreasing trend in the overall age-adjusted incidence rates were observed during the period 1986 to 2000, with an yearly decrease of 1.70%. This decrease was significant for men above the age of 40, but for young adult men below the age of 40, there was no significant decrease, the level being stable. In females, the overall decreasing trend in the age-adjusted incidence rates of oral cancers was not significant, but in the age group 40-59, a significant decline was observed. The probability estimates indicated that one out of every 57 men and one out of every 95 women will contract any oral cancer at some time in their whole life and 97% of the chance is after he or she completes the age of 40. CONCLUSION: The observed decreasing trend in oral cancers in Indian men may be attributed to a decrease in the usage of pan and tobacco. The high prevalence of the usage of smokeless tobacco among young adult men and women may explain the stable trend in oral cancer incidence in this group. These findings help to strengthen the association between tobacco use and oral cancer risk.

Population-based survival from cancers of breast, cervix and ovary in women in Mumbai, India.

BACKGROUND: Breast, cervix and ovarian cancers contribute more than 45% of the total in women in Mumbai and survival proportions for these neoplasms are very high in most developed populations in the World. The authors here report and discuss the population-based survival for these cancers in Mumbai, India. METHODS: Follow-up information on 4865 cancers of breast, cervix and ovary, registered in the Mumbai Population Based Cancer Registry for the period 1992-1994 was obtained by a variety of methods, including matching with death certificates from the Mumbai vital statistics registration system, postal/telephone enquiries, home visits and scrutiny of medical records. The survival for each case was determined as the duration between the date of diagnosis and date of death, date of loss to follow-up or the closing date of the study (December 31(st), 1999). Cumulative observed and relative survival was calculated by the Hakulinen Method. For comparison of results with other populations, age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative survival to the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test was used in univariate analysis to identify the potentially important prognostic variables. The variables showing statistical significance in univariate analysis were introduced stepwise into a Cox Regression model to identify the independent predictors of survival. RESULTS: The 5-year relative survival rates were 46.2% for breast, 47.7% for the cervix and 25.4% for the ovary. Higher survival was observed for those younger than 35 years for all these three sites. For each, survival declined with advancing age. Single patients who remained unmarried had better survival. For all sites Muslims had a better and Christians a lower survival as compared to Hindus. Education did not appear to be of significance. Survival decreased rapidly with advancing clinical extent of disease for all sites. With localized cancer, 5-year rates ranged from 54.7% to 69.3%, for regional spread 20.4% to 41.6% and distant metastasis not a single site recorded more than 5%. On multivariate analysis, age and extent of disease emerged as independent predictors of survival for all the sites. CONCLUSION: All the sites included in the study demonstrated moderate survival rates with significant variation. Comparison with other populations revealed lower survival rates as compared to developed countries, particularly for breast and ovary. In Indian populations survival proportions did not show much variation for these cancers. Early detection and treatment are clearly important factors to reduce the mortality from these cancers.

Decreasing trend in the incidence of stomach cancer in Mumbai, India, during 1988 to 1999.

The time trend in incidence of stomach cancer in males and females in Mumbai, India during 1988 to 1999 was estimated using data collected by the Bombay Population-based Cancer Registry. During the 12-year period, a total of 3657 stomach cancer cases (3.9% of all cancers) were registered by the Bombay Population-based Cancer Registry of which 2467 (5.1% of all male cancers) were in males and 1184 (2.6% of all female cancers) in females. For evaluation of the trend, we applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage changes were also computed for the incidence rates for evaluating the time trend. A statistically significant decreasing trend in the overall age-adjusted incidence rates of stomach cancer was observed during the period 1988 to 1999, with an yearly decrease of 4.44% in males and 2.56% in females. This decrease was most striking in males in the age groups 40-59 and 60+, and in females only in the age group 40-59. The probability estimates indicated that one out of every 92 men and one out of every 187 women will contract a stomach cancer at some time in their whole life and 95% of the chance is after his or her 40th birthday. The decreasing trend in the age-adjusted incidence rates of stomach cancer in both the sexes indicates that there is a critical change in the etiology of this cancer. The findings may provide clues relating to various life-style and environmental changes impacting on stomach cancer incidence.