Soft tissue sarcoma: the predominant primary malignancy in the retroperitoneum.

Purpose. In the clinical work-up of a retroperitoneal mass, the diagnosis of soft tissue sarcoma is often not considered. Incidence rates of various malignant and benign retroperitoneal tumours were studied to determine the incidence of soft tissue sarcoma in comparison with other neoplasms in the retroperitoneal space.Method. Nation-wide data on retroperitoneal tumours, collected prospectively over a 5-year period (1 January 1989- 1 January 1994), were supplied by the Netherlands Cancer Registry and The Dutch Network and National Database for Pathology.Results. Seven hundred and six patients with a primary retroperitoneal neoplasm were identified; 566 patients had a malignant tumour (80%). A soft tissue sarcoma (STS) was the most frequently diagnosed malignant tumour (n = 192), The agestandardised incidence of retroperitoneal STS was 2.5 per million person-years. The male/female ratio for STS was 0.73. In females, STS comprised 41%of all malignant retroperitoneal tumours, carcinoma of unknown primary tumour site (CUP) comprised 31%, and malignant lymphomas (ML) comprised 22%, whereas in males these values were 28% (STS), 30% (CUP), and 32% (ML), respectively.Discussion. Soft tissue sarcomas, albeit rare, are relatively common primary tumours in the retroperitoneum, especially in women.

Hypertension and breast cancer risk in a 19-year follow-up study (the DOM cohort). Diagnostic investigation into mammarian cancer.

BACKGROUND: To investigate whether hypertension and the use of anti-hypertensive drugs are associated with breast cancer risk. METHODS: This was a prospective study of 11, 011 women living in Utrecht, the Netherlands, aged 50-65 years at enrolment in a breast cancer screening project (DOM cohort). Women attended screening rounds between 1974 and 1985 at which blood pressure was measured and information on drug use and breast cancer risk factors was ascertained. Since 1974 (median follow-up time 19 years), information on breast cancer occurrence and death has been registered. Hypertension was defined as a systolic blood pressure > 160 mmHg or a diastolic blood pressure > 95 mmHg or current use of drugs for the indication hypertension. Cox's regression analysis was used to investigate the association between hypertension (treated or untreated) and subsequent breast cancer risk. Analyses were adjusted for age, body mass index, height, parity, familial breast cancer, smoking and oral contraceptive use. RESULTS: A total of 523 women were diagnosed with breast cancer. Hypertensive women experienced a statistically significant increased breast cancer risk of 23% (age-adjusted hazard ratio (HRa) = 1.23; 95% confidence interval (CI) 1.01 -1.49). After adjustment for all confounders, the increase was 14% (HR = 1.14; 95% CI 0.93-1.40). The decline in risk was mainly attributable to the effect of BMI. The risk was similar in treated (HR = 1.22; 95% CI 0.91-1.63) and untreated hypertensive women (HR = 1.13; 95% CI 0.91-1.40). CONCLUSION: These results do not support an association between hypertension and breast cancer, and if there is a link, it is likely to be positive and relatively small in size (+14%). This relation, if present, is not attributable to anti-hypertensive drugs, since the relation is also present in non-drug users.

Epidemiologic data on vulvar cancer: comparison of hospital with population-based data.

Data on vulvar cancer are subject to a possible selection bias because older patients with vulvar cancer are sometimes not referred to specialized centers. The aim of this study was to compare the variables obtained from the population as a whole with variables obtained from referral and nonreferral hospitals. Population-based data on age, stage, histological type, and treatment modality were registered for 138 patients with vulvar cancer. The characteristics of the patients who were referred to a gynecologic oncology center were compared with those of the patients treated in nonreferral hospitals. The age-adjusted incidence was 2.3 per 100,000 women. Basal cell cancer was less common in the referral center than in the nonreferral centers (3% versus 28%). No difference was found in FIGO stage distribution in the different subgroups. Groin node dissection was omitted in 80% of the patients not referred to a center. Omission of groin node dissection was more common in patients older than 74 years (P = 0.002). Population-based data on vulvar cancer differ significantly from hospital-based data and give better insight into the real characteristics of patients with vulvar cancer.

The capture-recapture method for estimation of cancer registry completeness: a useful tool?

BACKGROUND: In this paper we investigated whether the capture-recapture method is useful for a cancer registry to monitor its completeness of case ascertainment on a routine basis. METHODS: The capture-recapture method was used to estimate the completeness of case ascertainment in three regional cancer registries in the Netherlands, which are based on case finding by pathology laboratories and hospitals. RESULTS: Completeness was estimated to be 98.3%. The estimate of completeness was dependent on age and cancer site, with lower estimates of completeness for skin cancer and lymphatic and haematopoietic malignancies and for the age group > or = 75 years. CONCLUSIONS: A major drawback of the capture-recapture method is its inability to estimate the number of cases that are not routinely notified to the registry by one or both notification sources. Another limitation is the lack of statistical power to detect incompleteness in an early stage. It is concluded that the capture-recapture method is not useful for everyday surveillance of completeness in cancer registration.

Risk of endometrial cancer after tamoxifen treatment of breast cancer.

Since large trials have been set up to assess whether tamoxifen decreases the risk of breast cancer in healthy women, it has become important to investigate the drug's potential adverse effects, including occurrence of endometrial cancer. We undertook a case-control study in the Netherlands to assess the effect of tamoxifen on the risk of endometrial cancer after breast cancer. Through the population-based Netherlands Cancer Registry and two older, hospital-based, registries, we identified 98 patients who had endometrial cancer diagnosed at least 3 months after a diagnosis of primary breast cancer. Detailed information about treatment was obtained for all these patients, and for 285 controls, who were matched to the cases for age, year of breast cancer diagnosis, and survival time with intact uterus. Tamoxifen had been used by 24% of patients with subsequent endometrial cancer and 20% of controls (relative risk 1.3 [95% CI 0.7-2.4]). Women who had used tamoxifen for more than 2 years had a 2.3 (0.9-5.9) times greater risk of endometrial cancer than never users. There was a significant trend of increasing risk of endometrial cancer with duration of tamoxifen use (p = 0.049), and also with cumulative dose (p = 0.046). The duration-response trends were similar with daily doses of 40 mg or 30 mg and less. These findings support the hypothesis that tamoxifen use increases the risk of endometrial cancer. This oestrogenic effect on the endometrium was not related to the dose intensity. Physicians should be aware of the higher risk of endometrial cancer in tamoxifen users.