Long-term survival experience of female patients with genital cancer.

Survival analyses of patients with cancer of the cervix uteri, corpus uteri or ovary registered at Cambridge in 1960-1979 show that, although the long-term survivors had mortality rates similar to those of a normal age-matched population and might therefore be considered 'statistically cured', their risk of dying from their original cancer was still much higher than normal. Death rates from other cancers were slightly increased in cervix patients but not in corpus and ovary. At all three sites there was no evidence that deaths from non-malignant causes were increased. Only in cancer of the ovary was survival significantly better for patients registered in 1970-1979 than for patients registered in 1960-1969.

Prevalence of human papillomavirus type 16 DNA in cervical carcinoma samples in East Anglia.

A substantial increase in the incidence of severely dysplastic cervical lesions (CIN 3) has been observed during the period 1975-1982 in the East Anglian region of England. Since patients with severe dysplasia have an enhanced risk of developing cervical carcinoma, it seems possible that a substantial increase in the rate of cervical carcinoma is likely to occur in the near future. Evidence of a relationship between human papillomavirus (HPV) infection and cervical carcinoma has accumulated recently. We have studied the incidence of HPV16 DNA in cervical tissue samples from patients with cervical carcinoma, severe dysplasias and normal controls. Five out of 11 invasive squamous carcinomas of the cervix, 3/4 dysplasias and 0/12 normal samples were positive in Southern blot assays for HPV16 DNA. Some of the tissue samples had as many as 500 copies of HPV16 DNA per cell. The amount of HPV16 DNA present correlated with the aggressiveness of tumour growth.

A comparison of two doses of tamoxifen (Nolvadex) in postmenopausal women with advanced breast cancer: 10 mg bd versus 20 mg bd.

In a comparative double-blind trial involving 263 postmenopausal women with advanced breast cancer treated with tamoxifen, the mean objective tumour response rate and duration was 32% and 15 months respectively. No significant difference was found in clinical response and adverse effects between those randomised to 10 mg and those to 20 mg twice daily. Although the mean serum concentration of tamoxifen in the 20 mg bd group was significantly higher no correlation between serum level and clinical benefit was demonstrated.

Age and survival in prostatic carcinoma.

Several studies of patients with prostatic carcinoma have reported worse survival rates for younger patients (less than 60 years) than for older and have concluded that this disease takes a more aggressive form in younger patients. We have retrospectively analysed data on 597 patients in East Anglia between 1973 and 1977 and have shown that in this region younger patients have a much better prognosis when compared with older groups with the same disease. When age-correction is applied, their prognosis still appears no worse than in older patients. This has implications in the management of patients with this common cancer.

The pattern of presentation of carcinoma of the uterine cervix in East Anglia 1960 to 1975.

Changes in the pattern of presentation of carcinoma of the uterine cervix between 1960 and 1975 were studied using the records of 3193 patients registered with the East Anglian Cancer Registration Bureau. Between 1963 and 1968, an increased registration rate for invasive tumours was largely attributable to increased registrations of Stage I and II lesions in the 35 to 49 age group. After 1970 the registration rate for lesions of all stages in this age group declined. Over the same period the 50 to 64 age group showed a tendency for an increased proportion of registrations to be of Stage I or II lesions. There was little change in pattern in the over-65 age group. The possible relation of these changes to the introduction of a cervical cytology screening programme and the implications for future screening policies are discussed.

Carcinoma of the breast in East Anglia 1960-1975: a changing pattern of presentation?

A study was made of the clinical stage at presentation in 10 081 cases of carcinoma of the breast registered with the East Anglian Cancer Registration Bureau between 1960 and 1975. Information about the length of clinical history was obtained in 8862 cases. There has been a gradual increase in the population-adjusted incidence of breast carcinoma in the region during the period studied. Since 1968, there has been a consistent increase in Stage I and II registrations, but a fall in Stage III registrations. Stage IV registrations have remained constant. A greater proportion of women with Stage I or II lesions present with a short clinical history, and this pattern has not changed during the course of the study. We suggest that increased interest in, and opportunities for, the early diagnosis of breast disease are leading to a change in the pattern of presentation.