Reliability of medical records in diagnosing inflammatory breast cancer in Egypt.

BACKGROUND: Inflammatory breast cancer (IBC) is a rare, aggressive breast cancer diagnosed clinically by the presence of diffuse erythema, peau d'orange, and edema that arise quickly in the affected breast. This study evaluated the validity of medical records in Gharbiah, Egypt in identifying clinical signs/symptoms of IBC. For 34 IBC cases enrolled in a case-control study at the Gharbiah Cancer Society and Tanta Cancer Center, Egypt (2009-2010), we compared signs/symptoms of IBC noted in medical records to those recorded on a standardized form at the time of IBC diagnosis by clinicians participating in the case-control study. We calculated the sensitivity and specificity of medical records as compared to the case-control study for recording these signs/symptoms. We also performed McNemar's tests. RESULTS: In the case-control study, 32 (94.1%) IBC cases presented with peau d'orange, 30 (88.2%) with erythema, and 31 (91.2%) with edema. The sensitivities of the medical records as compared to the case-control study were 0.8, 0.5, and 0.2 for peau d'orange, erythema, and edema, respectively. Corresponding specificities were 1.0, 0.5, and 1.0. p values for McNemar's test were <0.05 for all signs. Medical records had data on the extent and duration of signs for at most 27% of cases for which this information was recorded in the case-control study. Twenty-three of the 34 cases (67.6%) had confirmed diagnosis of IBC in their medical records. CONCLUSION: Medical records lacked information on signs/symptoms of IBC, especially erythema and edema, when compared to the case-control study. Deficient medical records could have implications for diagnosis and treatment of IBC and proper documentation of cases in cancer registries.

Geographic trends of tobacco-related cancers in Cyprus.

BACKGROUND: Causal relationships have been previously established between smoking and various cancers. In Cyprus, 39 % of men and 14 % of women reported daily smoking in 2008. The objective of this study was to compare the incidence of tobacco-related cancers to all other cancers by district and rural-urban classification to understand the impact of tobacco in Cyprus. METHODS: Data on lung, urinary bladder, oral, pharyngeal, head/neck, and laryngeal cancers were obtained from the Cyprus Cancer Registry (1998-2008). There were 3,635 patients with tobacco-related cancers and 18,780 with non-tobacco cancers. Univariate analysis comparing tobacco-related cancers and all other cancers were conducted with regards to age at diagnosis, age groups, sex, smoking status, disease stage, and rural/urban status, with a p-value of 0.05 considered significant. Smoking prevalence, lung cancer, and bladder cancer rates of Cyprus were also compared to a number of other European countries. RESULTS: Patients with tobacco-related cancers were older than those with non-tobacco cancers (mean age 67.2 ± 12.4 vs. 62.4 ± 17.1, p < 0.0001). Among those with tobacco-related cancers, 80.1 % were male compared to 45.4 % males with other cancer types. The proportion of ever smokers was higher among males compared to females in urban and rural districts. Sub-districts 41 (Age Adjusted Rate (AAR) 41.9, 95 % CI: 35.7-48.1), 60 (AAR 40.3, 95 % CI: 35.2-45.3), and 50 (AAR 36.3, 95 % CI: 33.8-38.7) had the highest rates of tobacco-related cancers. The overall tobacco-related cancer rate was the highest among males in urban districts (AAR 60.8, 95 % CI: 58.2-63.5). Among tobacco-related cancers, lung cancer had the highest overall AAR (17.9 per 100,000) while head and neck cancer had the lowest overall AAR (5.3 per 100,000). Additionally, even though Cypriot males aged 65-69 years old exhibited higher smoking prevalence than other European countries, the overall lung and bladder cancer rates were lower in Cyprus. CONCLUSION: Despite the high proportion of smokers in Cyprus, cancer rates are low compared to other countries. Future in-depth measurements of relevant risk factors and smoking exposure can help understand this phenomenon and provide insights for cancer prevention.

Changes in the pattern of Kaposi's sarcoma at Ocean Road Cancer Institute in Tanzania (2006-2011).

Tanzania has high human immunodeficiency virus and human herpes virus-8 rates linked to Kaposi's sarcoma. We conducted a study at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania to examine changes in proportions of Kaposi's sarcoma to all cancers over the period (2006-2011) of increased acquired immune deficiency syndrome management by anti-retroviral therapy. We included 1504 Kaposi's sarcoma cases from Ocean Road Cancer Institute and abstracted information regarding age, gender, human immunodeficiency virus and tuberculosis, anti-retroviral therapy duration and Kaposi's sarcoma lesions. Male Kaposi's sarcoma patients (59.6%) were older (42.1 ± 11.5 years) than women (40.4%) (36.2 ± 9.6 years). Kaposi's sarcoma proportions declined from 10.1% in 2003 to 7.4% in 2011. Being a woman was associated with increased oral and generalized lesions and higher numbers of lesion locations (odds ratio [OR] = 2.17, 95% confidence interval [CI]: 1.35, 3.51; OR = 1.49, CI: 1.08, 2.06; OR = 1.06, CI: 0.79, 1.41, respectively). Tuberculosis was associated with oral, generalized and number of lesion locations (OR = 2.08, CI: 1.10, 3.93; OR = 2.06, CI: 1.28, 3.33; OR = 1.88, CI: 1.19, 2.97, respectively). Anti-retroviral therapy duration showed a protective effect with oral, generalized and number of lesion locations (OR = 0.55, CI: 0.33, 0.91; OR = 0.73, CI: 0.52, 1.01; OR = 0.89, CI: 0.67, 1.18, respectively). With increasing number of patients receiving prolonged anti-retroviral therapy, future studies should investigate long-term effect of anti-retroviral therapy and tuberculosis in Tanzania and countries with human immunodeficiency virus infection.