Treatment Cost and Psychological Impact of Burkitt Lymphoma on Ghanaian Families and Caregivers.

OBJECTIVE: Before June 2022, the treatment cost of Burkitt lymphoma (BL) in Ghana was mainly borne by the child's family or caregiver. We determined the treatment cost of BL in children and its psychological impact on parents and caregivers. METHOD: This prospective observational study assessed the direct medical and nonmedical costs (US dollars [USD]) incurred during the treatment of a child with BL for 6 consecutive months using a cost diary. Productivity losses and the psychological impact on parents and caregivers were assessed using a self-administered questionnaire and the Caregiver Quality of Life Index-Cancer (CQOLC). RESULTS: Of the 25 participants, 7 abandoned the treatment of their children, and 4 withdrew because the children passed away. The median (Q1, Q3) cost for treating BL per child for caregivers/parents (N = 12) was USD 947.42 (USD 763.03, USD 1953.05). Direct medical costs formed 71% (USD 11 458.97) of total treatment costs. Working hours of parents before the child's cancer diagnosis decreased from a median (Q1, Q3) of 44.00 (20.00, 66.00) hours to 1.50 (0, 20.00) hours after the diagnosis. The mean (SD) CQOLC score was 107.92 (15.89), with higher scores in men (111.00 [17.26]), married participants (111.26 [17.29]), Higher National Diploma certificate holders (113.00 [1.41]), and participants earning a monthly income more than USD 84.60. CONCLUSION: Treatment costs reduced the overall household income of 5 families. Parents and caregivers experienced reduced work hours and loss of employment. CQOLC scores were higher in married participants, those with a higher educational background, and those with higher income.

Tumour characteristics of bilateral screen-detected cancers and bilateral interval cancers in women participating at biennial screening mammography.

BACKGROUND: Unilateral interval breast cancers show less favourable prognostic features than unilateral screen-detected cancers, but data on tumour characteristics of bilateral interval cancers in a systematically screened population are sparse. Therefore, we compared tumour characteristics of bilateral interval cancers with those of bilateral screen-detected cancers. METHODS: We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all recalled women and of all women who presented with interval breast cancer. In women with synchronous bilateral breast cancer, the tumour with the highest tumour stage was defined as the index cancer. For comparison of data between both groups Fisher exact test and Chi-square test were used. RESULTS: Synchronous bilateral cancer was diagnosed in 2.2% of screen-detected cancers (64/2947) and in 3.2% of interval cancers (24/753) (P = 0.1). Index tumours of bilateral screen-detected cancers and interval cancers showed similar characteristics, except for a larger proportion of T-stage 2 or worse (T2+) cancers among interval cancers (16/24 (66.7%) versus 23/58 (39.7%) (P = 0.03). Index cancers, compared to contralateral cancers, were less frequently stage T1 in both bilateral screen-detected cancers and bilateral interval cancers (35/64 (60.3%) versus 40/64 (88.9%) (P = 0.001) and 8/24 (33.3%) versus 18/24 (85.7%) (P < 0.001), respectively). In bilateral screen-detected cancers, contralateral cancers were more often stage 1a-c (P < 0.001) compared to index cancers. In bilateral index cancers, index cancers were more often of the lobular subtype (P < 0.001). CONCLUSION: Index cancers of bilateral screen-detected cancers and bilateral interval cancers show significant differences in tumour size, whereas nodal status, receptor status and final surgical treatment are comparable. In bilateral screen-detected cancer, index cancers had a significantly higher tumour stage. In bilateral screen-detected cancer, index cancers were more often the ductal invasive subtype compared to contralateral cancers.

Reproducibility of Index Lesion Size and Mean Apparent Diffusion Coefficient Values Measured by Prostate Multiparametric MRI: Correlation With Whole-Mount Sectioning of Specimens.

OBJECTIVE: The purpose of this study is to determine the intra- and interreader agreement for index lesion size and mean apparent diffusion coefficient (ADC) value measurements performed by five readers using whole-mount histopathologic specimens processed with a patient-specific, MRI-based, 3D-printed mold as the standard of reference. MATERIALS AND METHODS: All men who underwent multiparametric MRI of the prostate performed using a 3-T scanner with endorectal and phased-array surface coils, followed by prostatectomy conducted between November 2015 and July 2016 at our institution, were identified. MRI examinations were independently reviewed by five readers with varying degrees of experience, two of whom had essentially no experience in prostate MRI interpretation before the study, to assess index lesion size and ADC values. A linear mixed model-based intraclass correlation was used to assess intra- and interreader reader agreement for lesion size and ADC measurements and agreement for size measurements between pathologic analysis and readers. RESULTS: A total of 80 men met the study eligibility criteria. Overall inter- and intrareader agreement for ADC measurements was excellent, with interclass correlation coefficient (ICC) values of 0.84 and 0.90, respectively; both inter- and intrareader agreement between experienced readers (0.82 and 0.92, respectively) and inexperienced readers (0.86 and 0.87, respectively) were excellent as well. The agreement between mean lesion size on imaging and histopathologic analysis ranged from poor (0.32) to good (0.66), with overall agreement considered fair (0.49). CONCLUSION: Readers with varying degrees of experience achieved good-to-excellent agreement for index lesion size and ADC values on multiparametric MRI of men with prostate cancer. This degree of reproducibility may improve preoperative risk stratification, informed decision making, and treatment planning for men with known or suspected prostate cancer.

Incidence and tumour characteristics of bilateral and unilateral interval breast cancers at screening mammography.

BACKGROUND: Detected by screening mammography, bilateral breast cancer has a different pathological profile compared to unilateral breast cancer. We investigated the incidence of bilateral interval breast cancers and compared their characteristics with those of unilateral interval breast cancers. METHODS: We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all referred women and of all women who presented with interval breast cancer. The tumour with the highest tumour stage (index cancer) was used for comparison with unilateral interval cancers. RESULTS: A total of 753 interval cancers were detected, of which 24 (3.2%) were bilateral. Among the invasive interval cancers, bilateral cancers more frequently showed a lobular histology than unilateral cancers (37.5% (9/24) vs. 16.1% (111/691), P = .01). There is a trend towards a larger proportion of bilateral than unilateral interval cancers graded 1 (45.8% (11/24) vs. 27.8% (192/691), P = .08). There were no other statistically significant differences in tumour characteristics. Also, the proportion of interval cancers showing significant mammographic abnormalities at the latest screen was comparable for unilateral and bilateral interval cancers (23.0% vs. 25.0%, P = .9). DISCUSSION: Bilateral interval cancers comprise a small proportion of all interval cancers. Except of a higher proportion of invasive lobular cancers and a more favourable histological grade of invasive cancers, tumour characteristics are comparable for bilateral and unilateral interval breast cancers.

Índice de masa corporal e incidencia de cáncer: una revisión sistemática y meta-análisis de estudios observacionales prospectivos / Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies

1. Conclusiones de los autores del estudio. El incremento del Índice de Masa Corporal (IMC) se asocia a un elevado riesgo de cáncer. Los tipos de cáncer son diferentes entre ambos sexos y grupos étnicos. 2. Comentario de los revisores. En la última década se ha hablado mucho de la relación del cáncer con la obesidad. Lo interesante del presente estudio es que demuestra una fuerte asociación entre el aumento del IMC a algunos cánceres específicos, variando entre ambos sexos, localización geográfica y grado de afectación. En los varones el aumento del IMC de 5kg/m2 se asoció al adenocarcinoma esofágico, tiroides, colon y riñón; en las mujeres se observó la intensa asociación al cáncer de endometrio, vesícula biliar, riñón y adenocarcinoma esofágico.(AU)

1. Conclusions of the study's authors Increased Body Mass Index (BMI) is associated with an increased risk of cancer. The types of cancer differ between sexes and ethnic groups. 2. Reviewers' comments In the last decade there has been much discussion of the relationship between cancer and obesity. What is interesting about this study is that it shows a strong association between increased BMI and some specific cancers, ranging from sex, geographic location and degree of involvement. In men, the increase of 5kg/m2 BMI was associated with esophageal adenocarcinoma, thyroid, colon and kidney, whereas in females it was observed a strong association with endometrial cancer, gull bladder, kidney and esophageal adenocarcinoma.(AU)