Quantitative Evaluation of the Normal Cervix, Cervical Cancer, and Cervical Precancerous Changes Via Real-Time Shear Wave Elastography.

OBJECTIVES: The present study aims to evaluate the clinical application values of ultrasound real-time shear wave elastography (SWE) in the diagnosis and differential diagnosis of cervical cancer (CC). METHODS: A total of 285 married female patients were screened and divided into three groups according to the results of the pathological examination and the cervical ThinPrep cytologic test: 1) the CC group (n = 94); 2) the cervical intraepithelial neoplasia (CIN) group (n = 91); and 3) the normal control group (n = 100). The maximum Young's modulus (Emax), mean Young's modulus (Emean), minimum Young's modulus (Emin), and Young's modulus stability (Esd) in each group were measured and statistically analyzed. RESULTS: There were no statistically significant differences in Emax, Emean, Emin, and Esd values between the anterior and posterior cervical walls, premenopausal and postmenopausal women, and nonparturient and parturient women in the normal control group. The Emax, Emean, Emin, and Esd values in the CIN group showed no statistically significant differences in different periods when compared with the control group. The differences between the normal control group and the CC group were statistically significant; the CC group showed no statistically significant differences in Emax, Emean, Emin, and Esd values at different clinical stages and in different pathological types. The cutoff value of Emax for CC diagnosis, which was of the highest accuracy (89.7%), was 43.48 kpa. CONCLUSION: Ultrasound real-time SWE can be applied to CC diagnosis.

The Combined Measurement of Pelvic Organ Mobility and Hiatus Area Improves the Sensitivity of Transperineal Ultrasound When Detecting Pelvic Organ Prolapse.

Objective: To evaluate whether the combined measurement of pelvic organ mobility and levator hiatus area improves the sensitivity of transperineal ultrasound (the index test) for diagnosing pelvic organ prolapse (POP). Methods: We retrospectively recruited women who had been examined in a tertiary gynecological center for symptoms of lower urinary tract incontinence and/or POP between January 2017 and June 2018. We excluded patients who had undergone hysterectomy previously or those who had received corrective surgery. All subjects underwent a standardized interview, POP quantification (POP-Q) examination (a reference standard for patients and controls), and ultrasound measurements of the levator hiatus area at rest (rHA), on contraction (cHA), and on Valsalva (vHA). We also determined the mobility of the bladder neck (BNM), cervix (CM), and rectum ampulla (RAM). Receiver operating characteristic (ROC) curve analyses were performed to determine cut-off values for diagnosis. Diagnostic performance was assessed by sensitivity, specificity, and area under curve (AUC). Results: A total of 343 women were eligible for analysis, including 247 POP patients (stage 2-3 by POP-Q) and 96 controls. Compared with controls, POP cases had significantly higher values for rHA, vHA, cHA, BNM, CM, and RAM. Each parameter was identified as a significant discriminator for POP and controls, as determined by ROC curve analysis, although the cut-off value varied slightly between different parameters. The combination of rHA, vHA, and cHA (with any HA that was ≥ the cut-off) improved the sensitivity from 64-89 to 89-93%. The combination of pelvic organ mobility with rHA, vHA, and cHA, further increased the sensitivity from 89-93 to 95-97%. Conclusion: The combination of levator hiatus area and pelvic organ mobility improved the sensitivity of transperineal ultrasound in the diagnosis of POP, whether used as a frontline test to assist POP-Q grading or to monitor the effect of pelvic floor exercise programs.

Transvaginal Real-Time Shear Wave Elastography in the Diagnosis of Endometrial Lesions.

BACKGROUND: To explore the value of transvaginal real-time shear wave elastography (SWE) in the diagnosis of endometrial lesions. METHODS: A total of 140 female patients with endometrial lesions, confirmed by pathological results, were divided into three groups: 45 cases of endometrial polyps, 29 cases of endometrial hyperplasia and 66 cases of endometrial cancer. A total of 100 cases of normal endometrium were used as the control group, including 52 cases in the proliferative stage and 48 cases in the secretory stage. Transvaginal real-time shear wave elastography was performed in all four groups. RESULTS: Emean, Emax and Esd were expressed as the average standard deviation. Among the control group, the results were 26.24±9.74, 38.09±9.18, and 4.25±2.73 kPa, respectively, in the proliferative endometrium cases and 12.51±7.46, 27.22±11.32, 4.40±2.52 kPa, respectively, in the secretory endometrium cases. Among the experimental group, the result was 15.68±8.18, 27.28±10.28 and 3.62±1.81 kPa respectively in the endometrial polyps cases; 21.20 ± 12.57, 36.32 ± 15.04, and 5.09 ±3.93 kPa in the endometrial hyperplasia cases; 49.36±25.51, 86.66±42.27 and 14.86±10.63 kPa in the endometrial cancer cases. The difference was statistically significant (P <0.05). When the truncation values of Emean, Emax and Esd were 28.50, 52.45 and 9.05 kPa, respectively, to distinguish between normal endometrium and endometrial cancer, Emax has the highest diagnostic value. CONCLUSION: Real-time SWE technology might be used as an auxiliary method in the diagnosis and differential diagnosis of endometrial cancer. More quantitative indicators are conducive to diagnosis.

Application Value of Real-Time Shear Wave Elastography in Diagnosing the Depth of Infiltrating Muscular Layer of Endometrial Cancer.

OBJECTIVE: To explore the clinical value of real-time shear wave ultrasonic elastography in diagnosing the depth of infiltrating muscularis of endometrial cancer. METHODS: Seventy-one patients with stage I endometrial cancer infiltrating the myometrium and 37 patients with normal physical examination were enrolled and divided into three groups: endometrial cancer superficial muscle infiltration group, endometrial cancer deep muscle infiltration group, and normal control group. After completing 2-dimensional ultrasound examination, each patient switched to the real-time shear wave elastography mode to measure the elasticity values Emax, Emean, and Esd. RESULTS: For control group, comparison of elastic modulus values between superficial muscular layer near the intimal surface and the deep muscular layer near the serosa surface showed no difference (P > 0.05). For endometrial cancer superficial muscular infiltration group, significant difference was found regarding the elastic modulus values of infiltrated muscular layer and uninfiltrated muscular layer (Emax and Emean) without difference for Esd (P > 0.05). A significant difference of elastic modulus was observed between control group and deep myometrial infiltration group (P < 0.05) without difference of Emean or Emax but with difference of Esd. The accuracy in diagnosing muscular layer infiltration was 78.9% for Emax cutoff and 82.5% for Emean cutoff. The rate of using Emax ≥32.22 kPa or Emean ≥27.54 kPa as the ultrasound standard for diagnosing myometrium infiltration was 92.9%. The accuracy for the diagnosis of muscular layer infiltration was 96.1% for Emax cutoff, 94.1% for Emean cutoff and 86.3% for Esd cutoff. CONCLUSION: Real-time shear wave elastography is helpful to determine the depth of infiltrating myometrium of endometrial cancer.

Site-Specific Variation in Familial Cancer as Suggested by Family History, Multiple Primary Cancer, Age at Onset, and Sex Ratio Associated With Upper, Middle, and Lower Third Esophageal and Gastric Cardia Carcinoma.

BACKGROUND: In China, esophageal squamous cell carcinoma (ESCC) and gastric cardia adenocarcinoma (GCA) differ in terms of multiple primary cancer (MPC) and male-to-female sex ratio (MFSR). METHODS: We studied site-specific variation in familial cancer by comparing family history (FH), MPC, age at onset (AO), and MFSR among 8768 patients with ESCC/GCA. RESULTS: ESCC/GCA patients with a positive FH are associated with a significantly higher rate of MPC and a younger AO than those without (sex-specifically: MPC 1.6% vs. 0.7%, P<0.01 and 3.2% vs. 0.8%, P<0.01; AO 53.1 ± 8.1 vs. 54.5 ± 8.2, P=0.000 and 52.9 ± 7.4 vs. 54.0 ± 8.0, P=0.005). Among patients with a positive FH, MPC decreases significantly from upper-, middle-, and lower-third ESCC to GCA (sex-specifically: 53.6%, 1.8%, 1.6%, 0.8%, P=0.000; and 71.4%, 1.5%, 2.2%, 1.6%, P=0.000). From MPC, upper-, middle-, and lower-third ESCC to GCA, AO increased sex-specifically: 51.9 ± 7.2, 52.8 ± 7.9, 52.1 ± 8.3, 54.3 ± 8.4, 55.6 ± 7.6 (P=0.000) and 49.3 ± 6.5, 51.8 ± 9.8, 52.6 ± 7.8, 54.4 ± 8.0, 55.7 ± 7.2 (P=0.000), and FH decreased: 43.8%, 35.1%, 28.2%, 29.5%, 24.4% (P=0.000) and 55.2%, 26.7%, 25.0%, 24.3%, 22.3% (P=0.000). The preponderance of males, smoking, alcohol consumption, and patients ≥50 years old increased from 2.2:1, 1.7:1, 1.0:1, 2.0:1 in ESCC to 6.1:1, 2.8:1, 2.5:1, 4.0:1 in GCA, yet more MPCs were associated with non-preponderant than preponderant counterparts; particularly in GCA, the difference was statistically significant. CONCLUSION: The proportion of familial cancer may decrease from upper-, middle-, and lower-third ESCC to GCA. This entails molecular investigation, and appreciating this may help us devise a better screening strategy or individualize cancer treatment.

Urban-rural disparity in cervical cancer in China and feasible interventions for tackling the rural excess.

According to GLOBOCAN 2012, age-standardized incidence rate (ASIR) of cervical cancer in developed and less developed countries is 9.9 vs. 15.7 per 100,000 population per year. This disparity is related to inequity in access to screening. Urban rural disparity in access to cervical cancer screening is similar in China. We aim to assess urban rural disparity in ASIR.Using population-based tumor registration data collected by us in urban Shijiazhuang city (with incidence data available for 1,217,437 women in 2012) and in Shexian County (with incidence data available for 197,416 women since 2000), we compared ASIR of cervical cancer between the two populations in 2012. We also analyzed the trend of biennial ASIR and averaged age at diagnosis of cervical cancer for 2000-2015 in Shexian County during which China was undergoing rapid changes in sexual mores. Finally, using previously published national death survey data, we compared age-standardized mortality rate (ASMR) of cervical cancer between Shijiazhuang city and Shexian County over the periods of 1973-1975 and 1990-1992.It was found that the ASIR of cervical cancer in rural Shexian County is 3 times higher than in Shijiazhuang city in 2012 (25.0 vs. 8.4 per 100,000 per year, P < .01); and the corresponding ASMR was 2 times higher over the period of 1973-1975 (25.0 vs. 13.0 per 100,000 per year, P < .01) and 8 times higher over the period of 1990-1992 (9.8 vs. 1.2 per 100,000 per year, P < .01). From 2000 to 2015 along with rapid changes in sexual behavior, the biennial ASIR of cervical cancer increased by +3.2% on average, from 19.3 to 28.5 per 100,000 per year (P < .01), and the biennial averaged age at diagnosis decreased from 55.8 to 52.1 (P < .01).Urban-rural disparity in ASIR of cervical cancer in present study is larger than that reported between developed and less developed countries in GLOBOCAN 2012, in which the disparity is considered "due to differences in access to screening." As in China, cytologists and infrastructure required for cervical cancer screening are similarly lacking in rural areas, we suggest cytological screening for cervical cancer be strengthened in disadvantaged rural settings.

Urban-rural disparity in colorectal cancer incidence and increasing trend in relation to socioeconomic development and urbanization in China.

Objective To study urban-rural disparity in colorectal cancer incidence and the increasing trend in relation to rapid socioeconomic development and urbanization in China. Methods We compared the age-standardized incidence rates (ASRs) of colorectal cancer between rural and urban areas in China in 2012 and analyzed the trend in Shexian County for 2000-2015 using population-based tumor registration data collected in Shijiazhuang city (2012) and Shexian County (2000-2015). Results The ASRs of colorectal cancer in Shijiazhuang (urban) were considerably higher than in Shexian (rural) in both men (22.8 vs. 11.9/100,000) and women (15.0 vs. 9.3/100,000). The difference was similar to that between countries with high and medium human development indices according to GLOBOCAN 2012. In trend analysis, the biennial ASR in Shexian increased from 6.6 in 2000-2001 to 15.9/100,000 in 2014-2015 in men (averaged biennial percent change (ABPC) = +6.0%), and from 4.0 to 11.7/100,000 in women (ABPC=+5.5%). Conclusions The incidence of colorectal cancer in China is rising in parallel with socioeconomic development and urbanization. Integrated efforts should be made to reduce the incidences of overweight and obesity in society to help prevent this increase.

Observational study pelvic ultrasound a useful tool in the diagnosis and differentiation of precocious puberty in Chinese girls.

Rapid and noninvasive diagnosis on and differentiation between normal, central precocious puberty (CPP), and isolated precocious puberty (IPP) is imperative before a decision can be made with gonadotropin-releasing hormone (GnRH) agonist treatment. Our study aims to evaluate such a role by pelvic ultrasound.We consecutively enrolled 84 cases of IPP (59 with premature thelarche/ pubarche and 25 with premature menarche), 47 CPP, and 177 age-matched normal controls. The IPP and CPP were diagnosed by clinical examination and GnRH-stimulation test and confirmed by over 2 years' follow-up. All subjects underwent pelvic ultrasound examination for length, width, thickness, volume of uterine/cervix/ovaries, fundal/cervical thickness ratio, endometrial thickness, and averaged maximal diameter of largest follicles. Statistical comparisons of these sonographic parameters between disease groups were made according to age intervals.It was found that between CPP and normal girls, 10 and 12 ultrasound parameters differed significantly in the >6 to 8 and >8 to 10 years age interval, respectively. Cervical thickness and endometrial thickness was the best discriminating parameter in the 2 intervals by receiver operating characteristic (ROC) curve analysis, and the cutoff, sensitivity and specificity associated with was 0.73 cm, 93.30%, 85.70%, and 0.26 cm, 76.92%, 100%, respectively. Between CPP and IPP, 2 and 5 parameters differed significantly in the >6 to 8 and >8 to 10 years age interval. Cervical length was the best discriminating parameter in both age intervals. The cutoff, sensitivity, and specificity associated were 1.49 cm, 93.33%, 55.17%, and 1.88 cm, 100%, 71.43%, respectively; Finally between normal and IPP girls, 4, 7, and 5 parameters differed significantly in the 0 to 6, >6 to 8, and >8 to 10 years intervals, respectively. Ovarian thickness, ovarian width, and cervix thickness was the best parameter for the 3 age interval respectively, and the cutoff, sensitivity and specificity associated were 0.98 cm, 76.46%, 84.85%, 1.39 cm, 85.71%,73.81%, and 0.75 cm, 90.48%, 64.21%, respectively.Our results indicate that pelvic ultrasonography could serve as a complementary tool for differentiation between normal girls and girls with different forms of sexual precocity in China. The best discriminating parameter changes according to precocity forms and age intervals.

Urban rural disparity in female breast cancer incidence rate in China and the increasing trend in parallel with socioeconomic development and urbanization in a rural setting.

BACKGROUND: Worldwide breast cancer incidence correlates with socioeconomic status and increases in parallel with westernization, however urban-rural disparity and trends have not been adequately investigated in China. METHODS: The age standardized rate (ASR) of female breast cancer by population-based cancer registration was compared between urban Shijiazhuang city and rural Shexian County in relation to socioeconomic status. The increasing trend of breast cancer in Shexian County from 2000-2015 was examined using Joinpoint analysis and the correlation with gross domestic product (GDP) per capita was analyzed. RESULTS: In 2012, the ASR of female breast cancer in Shijiazhuang was more than three times higher than in Shexian County (45.5/1 00 000 vs.13.8/1 00 000; P < 0.01) when the GDP per capita was 2.6 times higher (US$6964.80 vs. US$2700). In parallel with rapid socioeconomic development and urbanization, the biennial ASR of female breast cancer in Shexian county has increased significantly from 2.8/1 00 000 in 2000-2001 to 17.3/1 00 000 in 2014-2015, with an average biennial percent change of +10.2% (P < 0.01). The Pearson correlation between ASR and GDP was significantly positive (r = 0.94, P < 0.01). CONCLUSION: The incidence of breast cancer in women in China is increasing along with lifestyle westernization and changing reproductive patterns associated with socioeconomic development and urbanization. Urgent prevention measures, including the development of a healthy diet, giving birth at a younger age, an increase in breastfeeding, limiting menopause estrogen therapy, and control of alcohol consumption, are required.

Urban-Rural Disparity in Helicobacter Pylori Infection-Related Upper Gastrointestinal Cancer in China and the Decreasing Trend in Parallel with Socioeconomic Development and Urbanization in an Endemic Area.

BACKGROUND: Globally China has the largest urban-rural disparity in socioeconomic development, and the urban-rural difference in upper gastrointestinal cancer (UGIC) is similar to the difference between developed and developing countries. OBJECTIVES: To describe urban-rural disparity in UGIC and to emphasize prevention by socioeconomic development and urbanization in China. METHODS: Age-standardized incidence rates (ASRs) of cancers in 2012 were compared between urban Shijiazhuang city and rural Shexian County, and trends from 2000-2015 in Shexian County were analyzed. FINDINGS: Compared with urban Shijiazhuang city, the ASR of gastroesophageal cancers in rural Shexian County was 5.3 times higher in men (234.1 vs 44.2/100,000, P < .01) and 9.1 times higher in women (107.7 vs 11.8/100,000, P < .01). This rural-urban disparity in UGIC is associated with differences in socioeconomic development in annual gross domestic product (GDP) per capita of US$2700 vs US$6965, in urbanization rate of 48% vs 100%, and in adult Helicobacter pylori infection prevalence of 75% vs 50%. From 2000-2015, the GDP per capita in Shexian County increased from US$860 to US$3000, urbanization rate increased from 22.4% to 54.8%, and prevalence of H pylori infection among 3- to 10-year-old children decreased from 60% to 46.1% (P < .01). Meanwhile, the biennial ASR of esophagogastric cancer decreased 42% in men, from 313.5 to 182.1 per 100,000 (P < .01), and 57% in women, from 188.6 to 80.4 per 100,000 (P = .00). However, lung, colorectal, and gallbladder cancers and leukemia in both sexes and breast, ovary, thyroid, and kidney cancer in women increased significantly. Despite this offset, ASR of all cancers combined decreased 25% in men (from 378.2 to 283.0/100,000, P = .00) and 19% in women (from 238.5 to 193.6/100,000, P = .00). CONCLUSIONS: Urban-rural disparity in UGIC is related to inequity in socioeconomic development. Economic growth and urbanization is effective for prevention in endemic regions in China and should be a policy priority.

Heterogeneity in esophageal and gastric cardia precursor progression during six-year endoscopic surveillance after population-based screening in a Chinese high-risk region.

BACKGROUND: The study was conducted to examine esophageal and gastric cardia precursor progression. METHODS: After population-based baseline screening, 145 precursor and 335 chronic inflammation cases were endoscopically surveyed for six years. RESULTS: Surveillance of interval and baseline diagnoses for 18 severe dysplasia (SD) cases later detected were: 13, 23, 39, and 44 months since a diagnosis of chronic inflammation in four cases; 6, 6, 6, 11, 13, 16, 16, and 23 months since mild dysplasia (mD) diagnoses in eight; and 6, 9, 10, 13, 18, and 48 months since moderate dysplasia (MD) diagnoses in six. Rates for 11 carcinoma in situ (Cis) cases later detected were: 7 and 18 months since basal cell hyperplasia (Bch) diagnoses in two; and 6, 6, 9, 13, 13, 18, 35, 44, and 50 months since MD diagnoses in nine. In 10 cancer cases later detected, rates were: 6, 6, 7, 18, 19, 34, 36, and 48 months since SD diagnoses in eight cases with submucosal carcinoma; 46 months since MD diagnosis in a T 2 N 0 M 0 carcinoma case; and 52 months since Bch diagnosis in another T 2 N 0 M 0 case. CONCLUSION: Esophageal and gastric cardia precursors are heterogeneous. Male gender, advanced age, family history of upper gastrointestinal cancer, and multifocal dysplasia are significant independent predictors for progression, and Bch/mD, MD, and SD constitute three distinctive entities regarding the risk of cancer.

Incidence rate of female breast cancer in urban Shijiazhuang in 2012 and modifiable risk factors.

BACKGROUND: Breast cancer is diagnosed more frequently among urban than rural women in China; however, the incidence among women in Shijiazhuang is unknown. METHODS: As registered Chinese citizens are entitled to complete public medical insurance coverage, the incidence rate was estimated using reimbursement records of first hospitalization. RESULTS: Breast cancer is the most common cancer among women in Shijiazhuang. The crude rate and age-standardized incidence rates by China (ASRC) and world (ASRW) standards were 59.6, 48.5 and 45.5/100 000 in 2012. Mean age at diagnosis was 55.1 years. Incidence increased with age, peaking at 165.1 at 70-74. In comparison with urban women in other Chinese cities, incidence in Shijiazhuang was similar to Shanghai (ASRC 46.6) and Suzhou (ASRW 45). When compared with 31 other Chinese cities, Shijiazhuang ranked second highest behind Guangzhou (ASRW 46.6), and the ASRW correlated significantly with gross domestic product per capita among the 32 cities. The breast cancer ASRW in Shijiazhuang was 2.7 times the rate of 41 rural Chinese counties (17). When compared with GLOBOCAN 2012 data according to the Human Development Index, breast cancer incidence in Shijiazhuang matched countries with a high human development index (ASRW 45.2). CONCLUSION: Breast cancer incidence in Shijiazhuang in 2012 was the highest in China, matching the rate in countries with high social economic development. This rate may continue to rise, parallel with urbanization, and may be associated with changing reproductive patterns and Westernization. Prevention methods need to be incorporated.

Incidence rate of lung cancer in urban Shijiazhuang in 2012 with prevention implication.

BACKGROUND: Pollution has been established as an environmental factor in the development of lung cancer; however, the incidence rate in Shijiazhuang, one of China's most heavily polluted cities, is unknown. METHODS: As Chinese citizens are entitled to complete public medical insurance coverage, we estimated the lung cancer incidence rate among registered citizens of urban Shijiazhuang in 2012 using reimbursement records of first hospitalization. RESULTS: In Shijiazhuang, lung cancer was the most common cancer in men and the second most common cancer in women. The age standardized world incidence rate (ASRW) was 46.42 and 19.14/100 000, respectively, compared with 51.05 and 22.24/100 000, respectively, reported for 63 Chinese tumor registration cities in 2010 (the national level). However, age-specific rates for the 55-70 range in men and the 25-55 range in women were higher in Shijiazhuang than nationally. Compared with GLOBOCAN 2012 data, the lung cancer ASRW in Shijiazhuang was comparable to that of all industrialized countries (44.7 and 19.6/100 000), but higher than all developing countries (30.0 and 11.1/100 000), Japan (38.8 and 12.9/100 000), and Korea (45.5 and 16.2/100 000). CONCLUSION: The lung cancer incidence rate in Shijiazhuang matched the world's highest level in 2012. According to the experience of western countries, the incidence rate in China is expected to continue to rise over the next 40 years. Intervention is urgently required in order to reduce smoking prevalence by a third by 2025 and to take concrete legal action to reduce air pollution.

A 5.5-year surveillance of esophageal and gastric cardia precursors after a population-based screening in China.

BACKGROUND AND AIM: This study aimed to estimate the time to precursor progression and to identify significant predicators. METHODS: One hundred thirty-three precursor and 311 normal cases detected in a population-based screening were surveyed for 5.5 years. Precursor progression was defined as worsening of dysplasia or development of a new precursor. Time to precursor progression was estimated by the Kaplan-Meier method. Significant predicators were estimated by Cox proportional regression. RESULTS: Of the 133 precursor cases, 33.08% (44/133) progressed or recurred, 30.08% (40/133) persisted, and 36.84% (49/133) regressed; of the 311 normal subjects, 13.50% (42/311) developed a precursor. Progression occurred significantly earlier and more frequently with ncreasing histology: with mind dysplasia (mD), 7.8% progressed by 1 year and 23.3% progressed by 5 year; with moderate dysplasia (MD), 18% progressed by 1 year and 70% progressed by 5 years; and with severe dysplasia, 50% progressed by 1 year and 100% progressed by 5 years. The difference between any two groups was significant. In addition, the marginal Lugol-stained mucosa at endoscopic mucosal resection had a progressing risk similar to that of MD, and basal cell hyperplasia was similar to that of mD. Significant predicators for precursor progression included male sex (hazard ratio and 95% CI: 2.74 (1.63-4.60)), age over 50 years (2.31 (1.33-4.02)), family history of upper gastrointestinal cancer (UGIC) (1.56 (1.00-2.45)), multifocal dysplasia (5.11 (3.01-8.68)), and baseline histology. CONCLUSIONS: Sex, age, family history of UGIC, multifocal dysplasia, and baseline histology are significant independent predicators for precursor progression. Patients after endoscopic mucosal resection should be continuously surveyed.

Younger age of onset and multiple primary lesions associated with esophageal squamous cell carcinoma cases with a positive family history of the cancer suggests genetic predisposition.

BACKGROUND: Previous epidemiological studies have consistently found a positive family history of esophageal cancer is associated with a significantly increased risk of the cancer. However, whether the elevated risk could be attributed to common household exposure or inherited susceptibility is uncertain. This study aimed to highlight the effect of genetic predisposition by noting the significant differences in onset age and multiple primary cancers between esophageal squamous cell carcinoma (ESCC) cases with or without a positive family history of the cancer. METHODS: Age at onset and the percentage of multiple primary cancers were compared between ESCCs with (n = 766) or without (n = 1 776) a positive family history of the cancer in a consecutive surgery cohort at the Department of Thoracic Surgery of Hebei Tumor Hospital and the Fourth Hospital of Hebei Medical University. RESULTS: Overall, ESCCs with a positive family history of the cancer featured both a significantly younger age of onset and significantly more multiple primary cancers than those with a negative family history (onset age 51.83 vs. 53.49 years old, P < 0.01; percent of multiple primary cancers 5.50% vs. 1.70%, χ(2) = 25.42, P < 0.01). Both the differences were evident in subgroup analyses, but did not correlate. While age at onset differed significantly by family history among the male, smoking, and drinking groups, the difference of multiple primary cancers was significant among the otherwise nonsmoking, nondrinking, and younger onset age groups. CONCLUSIONS: Younger age of onset and multiple primary cancers associated with ESCCs with a positive, as opposed to a negative family history of the cancer, suggest a genetic predisposition. The results of subgroup analyses indicate a younger age of ESCC development results from the interaction of environmental and genetic risk factors, but multiple primary cancers may be related only to genetic predisposition.

Despite shared susceptibility loci, esophageal squamous cell carcinoma embraces more familial cancer than gastric cardia adenocarcinoma in the Taihang Mountains high-risk region of northern central China.

BACKGROUND: In China, esophageal squamous cell carcinoma (ESCC) and gastric cardia adenocarcinoma (GCA) share susceptibility loci, but different rates of multiple primary cancer and male/female ratio suggest the proportion of familial cancer is not equal. METHODS: The percent of cases with a positive family history, median onset age, rate of multiple primary cancer, and male/female ratio associated with upper, middle, lower third ESCC and GCA were compared to reveal the proportion of familial cancer. The 7267 subjects analyzed constituted all ESCC and GCA cases in whom the cancer was resected with cure intention between 1970 and 1994 at the 4th Hospital of Hebei Medical University. RESULTS: A positive family history for cancer was most often associated with the multiple primary ESCC and/or GCA cases, e.g. with 42% of the males and 59% of the females. For upper, middle, lower third ESCC and GCA, the percent of cases with a positive family history decreased by 38.5%, 26.3%, 26.5%, and 11.2% in males (P < 0.000) and 25.0%, 22.3%, 23.9%, and 9.8% in females (P < 0.0001). Median onset age increased from 49, 52, 55, to 56 years old in males and from 50, 53, 55, to 56 years old in females ( both P < 0.0001) for upper, middle, lower third ESCC and GCA. Male/female ratio increased from 2.2, 2.1, 2.2, to 6.2:1 for upper, middle, lower third ESCC and GCA (P < 0.0001). For upper, middle, lower third ESCC and GCA, the percent of multiple primary cancers decreased from 21.2%, 2.3%, 2.2%, to 1.5% in males and from 14.3%, 2.4%, 3.4%, to 3.1% in females. The preponderance of males, smoking, drinking, or onset-age ≥ 50 years was significantly higher in GCA than in ESCC, and the difference in the rates of multiple primary cancers between the preponderant and the non-preponderant cases was significant in GCA, but not in ESCC, suggesting non-equal requirement for genetic susceptibility when environmental hazards did not exist. CONCLUSIONS: The proportion of familial cancer in upper gastrointestinal carcinomas decreases by the primary site of upper, middle, lower third esophagus and gastric cardia. Considering familial and sporadic cancers differ in preventability, screening strategy and recurrence, our findings have basic and clinical implications.