Risk of Endometrial Cancer in Women with Diabetes: A Population-Based Retrospective Cohort Study.

The aim of this study was to examine the association between type 2 diabetes (T2DM), use of glucose-lowering medications and endometrial cancer (EC) risk. METHODS: The risk of EC incidence among women with T2DM in Lithuania was assessed using a retrospective cohort study design. Female patients who were registered with T2DM between 1 January 2000 and 31 December 2012 were identified in the National Health Insurance Fund database. EC cases (ICD-10 code C54) were identified from the Lithuanian Cancer Registry. Standardized incidence ratios (SIRs) were calculated by dividing the observed numbers of EC among patients with T2DM by the expected number of EC, calculated using national rates. RESULTS: A total of 77,708 diabetic women were included in the analysis, and 995 cases of EC were identified. A significantly increased EC risk in diabetic women was found as compared to the general population (SIR = 1.69, 95% CI 1.59-1.80). The greatest EC risk was found among younger patients at T2DM diagnosis, and the risk declined gradually with increasing age but persisted in being significantly increased among all age groups. The risk for EC increased with increasing duration of diabetes, and the highest EC risk was observed more than 10 years after T2DM diagnosis. A significantly higher EC risk than expected from the general population was found in all patient groups by glucose-lowering medication combinations. The lowest EC risk was observed in diabetic women who were users of "oral only" (without metformin) (SIR = 1.42, 95% CI 1.10-1.83) and "metformin only" (SIR = 1.69, 95% CI 1.49-1.92) medications. A two times greater EC risk was observed among the remaining glucose-lowering medication categories. In contrast, use of insulin only was not related to a higher EC incidence risk (SIR = 0.45, 95% CI 0.23-0.86); however, the risk estimation was based on nine cases. CONCLUSIONS: Our study shows a significantly increased EC risk in diabetic women as compared to the general population. In this study, a significantly higher EC risk was found in all patient groups by glucose-lowering medication combinations, except for insulin only users.

Breast Cancer Screening Program in Lithuania: Trends in Breast Cancer Mortality Before and During the Introduction of the Mammography Screening Program.

ABSTRACT BACKGROUND: Breast cancer is the most frequent oncological disease as well as the leading cause of cancer death among women worldwide. Decline in mortality in economically strong countries is observed. This decline is mostly related to early diagnosis (an improvement in breast cancer awareness and the mammography screening program (MSP)) and a more effective treatment. In the end of 2005, MSP started in Lithuania. The main aim of this article is to evaluate the breast cancer mortality during 22 years in Lithuania, as well as changes before the start of the MSP and during its implementation, in order to assess the influence of the MSP on mortality. MATERIALS AND METHODS: Analysis is based on data from the population-based Lithuanian Cancer Registry. Analysis of changes in mortality includes the period from 1998 to 2019. Age standardized mortality rates are calculated for assessment of changes. Joinpoint regression analysis is used. RESULTS: Applying the segmental regression model, it was found that during the study period mortality was statistically significantly decreasing by -1.1% each year. Mortality among women under the age of 50 decreased both before and during the implementation of MSP. Mortality in the target population also was already decreasing until the implementation of the program, but a significant reduction in mortality was observed in this group since 2006. CONCLUSIONS: Overall breast cancer mortality is decreasing in Lithuania. After the implementation of MSP the largest reduction in mortality was observed in the target population, however, it is not as pronounced as it could be with the well-organized MSP.

Reproductive Factors and Breast Cancer Risk in Lithuanian Women: A Population-Based Cohort Study.

ABSTRACT BACKGROUND: Although the relationship between reproductive factors and breast cancer is internationally proved, reliable data on former USSR countries are scarce. This study examines the association of parity, age at the first childbirth, number of children, and breast cancer risk in Lithuanian women. METHODS: The study that included women from 40 to 79 years old was based on a dataset that was made up linking all records from the 2001 census, all cancer incidence records from the Lithuanian Cancer Registry and all death records from Statistics Lithuania between 6th April 2001 and 31st December 2009. Cox's proportional hazards regression models were used to estimate the hazard ratios (HRs) for parity, age at the first childbirth, and number of children. RESULTS: If compared to nulliparous women, parous women had a lower risk of breast cancer (HR=0.84, 95% CI 0.78-0.89) and this risk further decreased with an increasing number of children. Women who gave birth after the age of 25 had a significantly higher risk of breast cancer. This disadvantage became statistically insignificant or decreased after controlling for total number of children. CONCLUSIONS: Parity and age at the first childbirth are strong predictors of breast cancer risk among Lithu-anian women.

Breast Cancer Screening Program in Lithuania: Interval Cancers and Program Sensitivity After 7 Years of Mammography Screening.

OBJECTIVE: Analysis of interval cancers is critical in determining the sensitivity of screening and represents an objective measure of the quality of mammography screening program (MSP). METHODS: Period analyzed: from 2006 to 2012. The rate of screen-detected, interval cancers and program sensitivity were measured. A comparison of screen-detected and interval cancers was performed. RESULTS: During the period of the study, 429 473 women were screened and 1297 were found to have cancer. The overall screen-detected cancer rate was 30.2 per 10 000 women screened. Four hundred thirty-one case of interval cancers have occurred during the period of the study. The interval cancer ratio (ICR) was 0.25. Overall sensitivity of MSP amounted to 75.1%. Slightly lower sensitivity was found among the youngest age-group, especially for those with lobular cancers. Interval cancers were bigger in size, more often with metastases in lymph nodes, than screen-detected cancers, but these differences were not statistically significant. CONCLUSIONS: Overall program sensitivity in Lithuania is about 75%, ICR is 0.25, and these parameters are comparable to other European countries.

Trends in Breast Cancer Incidence and Stage Distribution Before and During the Introduction of the Mammography Screening Program in Lithuania.

BACKGROUND:: The aim of this study was to analyze the incidence trends of localized and advanced breast cancer (BC) before and during the implementation of the mammography screening program (MSP) in Lithuania. METHODS:: The study period was divided into 2 intervals: the prescreening period (1998-2005) and implementation period (2006-2012). Analysis was performed for 3 age-groups: 0 to 49 years, 50 to 69 (target population), and older than 70. RESULTS:: In all age-groups, the incidence of localized BC has shown a steady increase, while the incidence of advanced stage BC has decreased. In the target population, during the study period, the stage I BC incidence increased statistically significantly by 10.3% per year (from 3.3 per 100 000 in 1998 to 12.2 per 100 000 in 2012). The increase in localized BC was faster in the period before the implementation of the MSP than during the implementation in 2006 to 2012 (10.3% and 5.7%). A slightly statistically significant decrease was observed for advanced BC during the study period (-1.1% per year), while during the implementation of the MSP, significant changes were not seen. CONCLUSIONS:: The results of our study indicate that the implementation of the MSP in Lithuania did not significantly influence trends of localized and advanced BC. Changes observed during the study period, including the prescreening and screening introduction periods, may reflect the general trends in the awareness of BC and improvements in diagnostics.

Diagnosis, treatment, and outcomes of encapsulated papillary carcinoma: a single institution experience.

BACKGROUND: Encapsulated papillary carcinoma (EPC) is a rare entity of breast cancer accounting for approximately 1-2% of all breast tumours. There are no evidence-based guidelines for the treatment of EPC. MATERIALS AND METHODS: From the database of the National Centre of Pathology (NCP), we obtained pathology reports of 19 patients with histologically confirmed EPC, who were treated at the National Cancer Institute (NCI) in Vilnius, Lithuania, between July 2009 and July 2015. Demographic, diagnostic and treatment data were collected from medical records retrospectively. RESULTS: During the indicated period, 19 patients with EPC were treated at the NCI. Three of them had pure EPC, they were 74 to 81 years of age at the time of diagnosis (mean 76.7 years, median 75 years); all of them are still alive and no disease progression has been observed. Seven patients had EPC associated with carcinoma in situ. Nine patients had EPC associated with invasive breast ductal carcinoma. All patients underwent surgery, in most cases - wide local excision. Only one patient died. CONCLUSIONS: EPC is a rare form of breast cancer and usually presents with an invasive breast carcinoma or carcinoma in situ in postmenopausal women. Tumours have an excellent prognosis in the cases of pure EPC and in both EPC associated with carcinoma in situ (CIS) and invasive carcinoma.

Rare types of breast carcinoma.

Breast cancer (BC) is a heterogeneous disease that encompasses several distinct entities with remarkably different characteristics. Histological type is one of important BC characteristics. Histological type is associated with differences in epidemiology, diagnostic issues, clinical course, prognosis. When we talk about BC, ductal and lobular carcinoma is usually what we have in mind. However, the other types that comprise less than 10% of BC are also very important. The rarity of many of these neoplasms does not allow large or randomized studies to define the optimal treatment. Many of the descriptions are from case reports and small series. The aim of this retrospective study was to analyze the data on rare breast cancers, to describe their main characteristics, and to calculate survival rates. We believe that the experience of our institution will contribute to the available data about these rare breast cancers and help in better understanding of this subgroup.

Targeted therapy in patients with non-small cell lung cancer previously treated with chemotherapy.

A case of successful and prolonged treatment of metastatic non-small cell lung cancer with the epidermal growth factor receptor antagonist erlotinib is presented. A never-smoker female was diagnosed with stage IV lung cancer in December 2005. A chest CT scan showed soft tissue mass 35×34 mm in size in the right lung with metastases in the lymph nodes and in the left lung. A biopsy revealed a poorly differentiated adenocarcinoma. The disease showed poor response to the first-line and second-line chemotherapy. Targeted therapy with erlotinib was started in February 2007. The most severe adverse event observed was grade 3 skin rash. The disease was stable until February 2009 when brain metastases were detected. Erlotinib was continued until May 2009 when disease progression in the lungs was confirmed. The patient died due to ongoing disease progression in December 2009. Retrospective genetic analysis of a tumor specimen was performed, and no mutations in EGFR exons 18-21 were detected. The patient had a significant clinical benefit for the period of 24 months. These results are consistent with previous reports in literature that clinical characteristics such as female gender, nonsmoker, adenocarcinoma histology, and severe cutaneous toxicity seem to predict good response to erlotinib. In the present case, erlotinib proved to be effective even in heavily pretreated, chemotherapy-resistant lung adenocarcinoma. So far, no exact predictive biomarkers of erlotinib effectiveness have been determined; and their further analyses are essential.