Adherence to the World Cancer Research Fund and the American Institute for Cancer Research lifestyle recommendations for cancer prevention and Cancer of Unknown Primary risk.

BACKGROUND & AIMS: The World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) updated their cancer prevention recommendations in 2018. Adherence to these recommendations has been associated with lower cancer risk and mortality. However, adherence in relation to Cancer of Unknown Primary (CUP) risk has not been studied. This study investigates whether adherence to the WCRF/AICR recommendations is associated with CUP risk. METHODS: Data from the prospective Netherlands Cohort Study on diet and cancer was used to measure adherence to the recommendations in relation to CUP risk. The cohort includes 120 852 participants (aged 55-69 years), who completed a self-administered questionnaire on cancer risk factors at baseline. Adherence was investigated with respect to body fatness, physical activity, plant foods, meat consumption and alcohol. Incident CUP cases were identified through record linkage to the Netherlands Cancer Registry and Dutch Pathology Registry. A follow-up of 20.3 years, resulted in 856 incident CUP cases and 3911 subcohort members with complete information available for case-cohort analyses. Multivariable adjusted hazard ratios were estimated using proportional hazards models and were adjusted for age at baseline, sex, cigarette smoking (status, frequency, and duration) and total energy intake. RESULTS: Highest adherence appeared to be associated with decreased CUP risk in the age-sex adjusted model (HR: 0.76, 95% CI: 0.62-0.92). After additional adjustment for cigarette smoking (status, frequency, and duration), the association attenuated and was no longer statistically significant. No multiplicative interactions were observed between sex nor smoking status and overall adherence in relation to CUP. CONCLUSION: Within this cohort, highest adherence to the WCRF/AICR recommendations is not statistically significantly associated with decreased CUP risk after multivariable adjustment.

Identificación de tumor primario en pacientes con metástasis como forma de presentación de cáncer / Identification of the primary tumor in patients with metastases presenting as cancer

INTRODUCCIÓN: hoy día el cáncer compite con la cardiopatía isquémica como primera causa de muerte en Cuba, muy por encima incluso de la enfermedad cerebrovascular, los accidentes y la neumonía. En muchos casos, el cáncer se presenta con metástasis y solo se logra identificar el tumor primario en una parte de ellos, mientras que en el resto, se mantiene "oculto" tras una investigación considerada "óptima". OBJETIVO: determinar la frecuencia con que se identifica en nuestro medio un tumor primario cuando el cáncer se ha presentado con metástasis, la distribución topográfica de los sitios de metástasis y las variantes histológicas en casos de tumor primario "oculto". MÉTODOS: estudio transversal, prospectivo y descriptivo realizado en el Servicio de Medicina Interna del Hospital Clinicoquirúrgico "Hermanos Ameijeiras" en el período comprendido de enero 2010 a enero 2013. El universo de trabajo estuvo constituido por 100 pacientes con metástasis sin primario identificado como diagnóstico de hospitalización, que cumplían los criterios de inclusión. Se utilizaron las variables: localización de tumor primario, sitios de metástasis y variedades histológicas. Se emplearon principalmente métodos de estadística descriptiva, especialmente los aplicables a variables cualitativas (incidencia). RESULTADOS: se logró identificar tumor primario en 50 pacientes. Las localizaciones más frecuentes fueron pulmón (11 %), colon, ovario y próstata (5 % en cada caso). En 50 % de los casos no se identificó tumor primario. El sitio más común de metástasis fue el hígado (56,0 %), seguido por los ganglios (41,0 %) y la pleura pulmón (19,0). En el caso de los pacientes en los que no se logró identificar el tumor primario, la variedad más frecuente fue adenocarcinoma bien diferenciado (42 %) seguida del carcinoma poco diferenciado (34 %) y el carcinoma neuroendocrino (20 %). CONCLUSIONES: en nuestro medio, se logra identificar tumor primario en la mitad de los pacientes que se presentan con metástasis . Ello es independiente del número de metástasis al momento de la presentación. El sitio de afectación metastásica más frecuente es el hígado. La variante histológica predominante entre pacientes con tumor primario "oculto" fue adenocarcinoma.

INTRODUCTION: today cancer competes with ischemic heart disease as the leading cause of death in Cuba, even far above cerebrovascular disease, accidents, and pneumonia. In many cases, cancer has metastasized and only the primary tumor is only identified in a part of them, while in the rest, the tumor remains "hidden" behind a research considered as "optimal". OBJECTIVE: to determine, in our context, how often a primary tumor is identified when the cancer has metastasized, the topographical distribution of metastasis sites and histological variants in cases of "hidden" primary. METHODS: A cross-sectional, prospective and descriptive study was conducted in the Department of Internal Medicine, at Hermanos Ameijeiras Clinical Hospital from January 2010 to January 2013. The working universe consisted of 100 patients with metastasis with no primary tumor identified as diagnosis of hospitalization, who met the inclusion criteria. Location of primary tumor, metastatic sites and histological types were variables used. Descriptive statistics were mainly used, especially those applicable to qualitative variables (incidence). RESULTS: primary tumor was identified in 50 patients. The most common sites were lung (11 %), colon, ovarian and prostate (5 % each). no primary tumor was identified in 50 % of cases. The most common site of metastasis was liver (56.0 %), followed by lymph (41.0 %) lung and pleura (19.0). the most common strain was well-differentiated adenocarcinoma (42 %) in those patients whose primary tumor failed to be identified; followed by the poorly differentiated carcinoma (34 %) and neuroendocrine carcinoma (20 %). CONCLUSIONS: In our context, identifying the primary tumor is achieved in half of the patients with metastases. This is independent of the number of metastases at presentation. Liver is the most common site of metastasis. The predominant histological variant among patients with "hidden" primary was adenocarcinoma.

Rapid reduction in the incidence of cancer of unknown primary. A population-based study.

BACKGROUND: Cancer of unknown primary (CUP) carries a dismal prognosis due to the two hallmarks of 1) being metastatic with 2) no known specific treatment. An organ-labeled diagnosis of cancer should therefore be sought. In this study, we have analyzed population-based incidence and survival data of CUP over the latest 40 years. MATERIAL AND METHODS: Complete national data on 23 004 CUP-patients from the Cancer Registry of Norway sampled from 1971 to 2010 are presented, with absolute and age-adjusted incidence rates correlated to the total cancer incidence. One-year relative survival rates were calculated. RESULTS: The incidence of CUP increased both in absolute numbers and as a fraction of total cancer incidence during the first half of the period. There has been a substantial decrease in incidence over the latest 20 years, now being responsible of only 1.7% and 1.2% of the total cancer incidence in females and males, respectively, with an age-adjusted incidence rate of 3.5 and 3.8, respectively. The one-year relative survival rate has increased and was slightly below 20% for both sexes in 2010. CONCLUSION: Better diagnostics, both radiological and pathological, is probably responsible for a substantially lower incidence. Improved treatment for cancers in general also benefits the CUP-group.

[Occult cancer and venous thromboembolism: which screening in patients with inaugural deep vein thrombosis?]. / Cancer occulte et maladie thromboembolique veineuse: quelle enquête étiologique devant une maladie thromboembolique veineuse inaugurale ?

The association between thrombosis and cancer, initially evidenced in metastatic patients is well recognized and now described in patients with occult cancer where venous thrombosis may be the first clinical manifestation (Trousseau's syndrome). In this review, clinical and epidemiological interactions between thrombosis and cancer are described in five distinct step: venous thrombosis during malignancy and occult cancer, period of large increased in the risk for diagnosis of cancer, patients or venous thrombosis with increased risk for occult cancer, extensive or not extensive screening for occult cancer, earlier occult cancer detection associated or not with improved treatment possibilities and thus prognosis.

Mass screening for endometrial cancer directed in risk groups of patients with diabetes and patients with hypertension.

BACKGROUND: The interest in mass screening programs for the early detection of endometrial cancer (EC) has grown with the rising incidence of this disease. Preliminary programs directed at asymptomatic women with only one risk factor, i.e. age, have not been cost-effective. METHODS: In the current study, 597 asymptomatic women from 45-69 years of age with diabetes and/or hypertension were screened by Vabra (Berkeley Medevices Inc., Berkeley, CA) aspiration. RESULTS: Among the women with diabetes, 6.3% preinvasive lesions of the endometrium were found. This is significantly more than the rate among women with hypertension, which was 1.3% (P < 0.01). CONCLUSIONS: Regular mass screening programs for the early detection of EC should be directed at asymptomatic diabetic women 45 years of age or older. This study does not indicate that similar screenings would be effective for women with hypertension.