The prognostic significance of sialyl-Tn antigen in women treated with breast carcinoma treated with adjuvant chemotherapy.

BACKGROUND: Sialyl-Tn (STn) represents an aberrantly glycosylated mucin epitope that is expressed in breast carcinoma and other adenocarcinomas and is an important factor in the development of novel immunotherapeutic approaches. The primary aim of the current study was to investigate the influence of STn expression on the prognoses of patients with breast carcinoma. METHODS: A cohort of 207 women diagnosed with invasive breast carcinoma who were treated with anthracycline-containing adjuvant chemotherapy and were enrolled in a randomized clinical trial were studied. Expression of STn was determined by an immunohistochemical procedure in which the B72.3 monoclonal antibody was used. Kaplan-Meier and Cox proportional regression survival analyses were used to compare low STn and high STn patients. RESULTS: Forty-eight (23%) of the 207 specimens demonstrated high STn staining (>25% cells were immunoreactive). During a median follow-up of 5 years, high STn patients had worse disease free survival than low STn patients (55% vs. 74%, respectively; P = 0.03). High STn expression was significantly associated with age (P = 0.04) but not with other conventional prognostic markers. In multivariate analysis using the Cox regression model, high STn emerged as an independent prognostic indicator for disease free survival (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.09-3.73) and for overall survival (HR, 2.16; 95% CI, 0.95-4.92). CONCLUSIONS: The results of this study suggest that STn may be a valuable marker for identifying women at high risk of developing recurrent breast carcinoma who may be candidates for trials investigating new therapies in combination with standard adjuvant therapy.

Factors related to enrollment in the breast cancer prevention trial at a comprehensive cancer center during the first year of recruitment.

BACKGROUND: Using an a priori theoretic model of behavior change, factors predicting enrollment in a randomized chemoprevention trial during the first year of recruitment were assessed prospectively. METHODS: Eligible participants were asked to complete a 90-item semistructured questionnaire after attendance at an informational meeting. Components of the Health Belief Model (including perceived susceptibility, perceived severity, perceived benefits and barriers, cues to action, and health motivation), health status, preventive health behaviors, and social influence were assessed in relation to enrollment. RESULTS: Overall, 331 women attended one of the meetings, and 73% completed a questionnaire; 45% enrolled on the trial and 55% did not. In bivariate analyses, all but one of the perceived barriers were associated negatively with enrollment; however, items assessing perceived susceptibility, perceived severity, and perceived benefits were not. Nonparticipants also were more likely to be over 49 years of age, to be currently or to have been on estrogen replacement therapy, and to have had hot flashes. In logistic regression analysis, not being able to take estrogen replacement therapy was the strongest predictor of nonparticipation (odds ratio [OR], 12.13, 95% confidence interval [CI], 3.63, 40.60). Other factors associated with nonparticipation were concern about side effects of tamoxifen (OR, 5.06; CI, 2.37, 10.80); the possibility of getting a placebo (OR, 7.75; CI, 1.51, 39.67); the costs associated with the trial (OR, 3.21; CI, 1.12, 9.24); and absence of concern that significant others would be reassured if the respondent was taking tamoxifen (OR, 2.58; CI, 1.04, 6.41). CONCLUSIONS: These findings support the view that recruitment efforts for chemoprevention trials should address barriers specific to their circumstances. In addition, increasing the support available from personal social networks may enhance recruitment to chemoprevention trials for breast cancer.

Physicians' management of health effects related to industrial exposures: two case reports.

Although physicians play a vital role in diagnosing and treating health effects related to industrial exposures, most physicians have limited training in occupational and environmental medicine. Two cases of industrial exposure, one affecting an individual and the other, a community, are described to illustrate the need for physicians' awareness of such exposure and their need to know how to manage potential health effects. Resources to assist in identifying and managing these exposures and their related conditions are discussed.

Reasons for participation and nonparticipation in a colorectal cancer screening program for a cohort of high risk polypropylene workers.

Little is known about reasons for participation in occupational colorectal cancer screening programs using flexible sigmoidoscopy and barium enema. To assess this issue, telephone interviews were conducted with a sample of participants and nonparticipants in such a program. This study was a follow-up of a previous assessment of factors that affected screening participation among a cohort found to have elevated rates of colorectal cancer. The major finding of this survey was that the absence of symptoms was the major reason for nonparticipation, although both participants and nonparticipants expressed the view that early detection was important and that colorectal cancer could be cured if treated at an early stage. Based on the results of this study and of other surveys, educational messages to workers explaining the asymptomatic development of colorectal cancer should be tried as a way of increasing participation.

Factors associated with participation in an occupational program for colorectal cancer screening.

This study reports factors associated with participation in a colorectal cancer screening program for a cohort of workers on a polypropylene manufacturing unit. The impetus for the screening program was the discovery of a colorectal cancer cluster among workers on this unit. The program included a life-style/risk factor questionnaire, fecal occult blood test, a 60-cm colonoscopy, and an air-contrast barium enema. Overall, 52.5% of the 406 men who were offered screening participated in the program. Of those screened, only 40% attended a briefing, but over 80% of those who attended a briefing came for screening. Factors associated with completion of screening are analyzed and discussed in the context of the literature on participation in colorectal screening programs. The implications for colorectal cancer screening of occupational groups believed to be at high risk are considered.

Comparison of participants and nonparticipants in a work site cancer awareness and screening program.

In 1985, Pennzoil Company offered a company-paid cancer awareness and screening program focusing on breast and colorectal cancers for its employees. Following a lecture/slide presentation, employees filled out a risk assessment questionnaire. Those at risk for breast and/or colorectal cancers were invited for consultation, mammography, and/or short colonoscopy. Overall completion rates were 49% for mammography, 20% for the fecal occult blood test, and 31% for short colon oscopy, but these rates varied by risk status. Moreover, the same demographic and risk factors were not consistently associated with completion of the same screening procedure across risk groups. Based on these findings, we suggest that different interventions may need to be developed depending on the risk characteristics of subgroups within the target population.