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Query: EC:6.2.1.1 (ACS)
 78,556 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Radical mastectomy as originally conceived at the turn of the century consisted of complete removal of the breast tissue, the overlying skin, the pectoral muscles, the intervening lymphatics and the axillary lymph nodes. The aim was logical but initially the results were poor. Only 41% of the 76 patients in Halsted's original series were without disease at the end of 3 years. The principal reason for this was the advanced stage of disease in the patients selected for treatment. By contrast, Gilbertsen, using clinical examination alone, surveyed women 45 years of age or older and found that of 32 patients with breast cancers detected by the screening procedure, 24 had no axillary lymph node involvement. The absolute 5-year survival rate of this group was 96%, which approaches the anticipated survival of comparable women free of breast cancer. Those with positive lymph nodes had an absolute survival rate of 75% at 5 years. Further, of 13 patients observed for 10 years, the survival rate for those without node involvement was 90% and for patients with node involvement was 33%. Patients treated at the Barnes Hospital in St. Louis between 1912 and 1933 were contrasted with similarly treated patients at the Barnes Hospital and the Ellis Fischel Cancer Hospital from 1940 to 1955. A poorer survival rate in the earlier series was related primarily to the greater frequency of advanced and larger tumors. That a significant reduction in breast cancer mortality can be achieved is becoming increasingly apparent. Among survey-detected breast cancers in the study conducted by the Health Insurance Plan of Greater New York, the 6-year mortality was half of that of controls. This reduction is even more impressive when one considers that among these patients were many with full invasive, mass-forming carcinomas at the time of initial screening. A recent report by Wanebo, Huvos and Urban discusses the treatment of prognostically favorable forms of breast cancer by modified radical mastectomy. It is possible to select from among their patients those who fit the definition of minimal breast cancer. In this group the 5-year survival rate was 97% and the 10-year survival rate was 95%. Only 1 patient died of breast cancer in 10 years. In another reported group of 65 patients with intraductal carcinoma only, there were no deaths due to breast cancer in 10 years. Should the NCI-ACS demonstration projects show, as now seems probable, that community screening programs can be effective in early breast cnacer detection, it is to be anticipated that widespread public demand for screening facilities will follow. This may present insurmountable logistic and economic problems. The total number of radiologists in the United States is not sufficient to screen annually the total population of women over age 40, or even over age 50. There is great need for the development of criteria for the ready identification of that segment of the population in which most of the cancers would be found...
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PMID:The detection and diagnosis of early, occult and minimal breast cancer. 18 91

Of 1,810 breast cancers detected in the NCI/ACS Breast Cancer Detection Demonstration Projects, 592 were less than 1 cm in diameter and considered minimal; and tissue slides from 506 of them were available for retrospective review by a panel of pathologists. The initial report of this review indicated that in 66 cases the pathologic features of the presented slides were not sufficient for diagnosis of cancer. Subsequent investigation revealed that, through computer error, the slides submitted in 2 of these 66 cases were not from the lesions in question but from blind biopsy of the contralateral breast. Further review by the pathology panel of tissue from 38 of the 64 remaining cases determined that 16 of the remaining lesions were indeed cancers or borderline malignant lesions. This then left 48 cases in doubt. Only biopsy had been performed in 11 of them, and some form of mastectomy in the other 37. The original pathologic opinion had been divided in 30 of these, and the mastectomy had been delayed for 1 day to 7 months after the biopsy. In only 7 of the 48 questionable cases was definitive treatment carried out at the time of biopsy. All in all, these findings reflect sound, responsible surgical judgment.
Cancer 1979 Mar
PMID:Diagnosis of minimal breast cancers in the BCDDP: the 66 questionable cases. 42 26

In a study population, can digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA) (monoclonal) effectively detect the majority of clinically relevant cancer? If this is possible, the remaining patients could then be considered for chemopreventive protocols. The American Cancer Society/National Prostate Cancer Detection Project (ACS/NPCDP) had a cancer detection rate of 2.4% for its initial year utilizing PSA, DRE and TRUS. TRUS and PSA detected 73% more cancer than DRE alone. TRUS detected a greater percentage of cancers than DRE (85% vs. 64%). PSA was > or = 4 ng/ml for 66% of prostate cancer patients; 11% of cancer patients had PSA < 2 ng/ml. PSA decision levels based on gland volume detected a subgroup at the 95th percentile that had a nine-fold increased risk for cancer. In a separate study differentiating benign prostatic hypertrophy (BPH) and cancer, we found 0.12 +/- 0.13 ng/ml/gm for serum PSA (sPSA)/gm BPH. This study proved that predicted PSA (pPSA) = gland volume x 0.12; this equation also functioned at the 95th percentile for any individual patient. Individual patient assessment: 1. Entry level PSA = 2 ng/ml. 2. Those patients with PSA > 2 ng/ml have TRUS determination of gland volume (performed by technician). 3. pPSA = gland volume x 0.12. If sPSA > pPSA then: 4. (sPSA-pPSA)/2 = predicted volume (cc) of cancer; 5. 3 square root of volume of cancer = mean diameter (cm) of cancer. Thus, these results should detect the majority of clinically relevant cancer (> 0.5 cc). PSA combined with TRUS and DRE can identify high risk groups for cancer.
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PMID:The role of digital rectal examination, transrectal ultrasound, and prostate specific antigen for the detection of confined and clinically relevant prostate cancer. 128 97

The success of the Pap smear in screening for cervical cancer illustrates many of the tenets of screening for disease. Unfortunately, no other gynecologic malignancy shares this success. Detection of most gynecologic malignancies occurs once they have become symptomatic and on clinical examination at the interval cancer-related checkup as recommended by the ACS. These examinations, done yearly in women older than 40 and every 3 years in younger women, can go a long way in the detection of genital tract disease. In detecting vulvar neoplasms, visual inspection of the entire perineum coupled with palpation to include Bartholin's glands and early biopsy of suspicious vulvar lesions promotes earlier diagnosis. Self-examination similar to breast self-examination and increased patient awareness are potential education goals for physicians as well as cancer and medical societies. Vaginal examination at the cancer checkup should continue. The finding that most vaginal cancers are picked up by abnormal cytology while they are still asymptomatic argues strongly for Pap testing after menopause. The knowledge that women who are status posthysterectomy for benign disease are not protected from developing vaginal cancers mandates continued Pap testing in this population as well. Because endometrial cancer is common, primary care physicians should maintain a high index of suspicion. Aspiration biopsy is a simple office-based procedure with low risk and good yield, and any woman in the perimenopausal and postmenopausal period who presents with atypical bleeding patterns should be evaluated. Although not recommended as a general screening test, the ACS does advocate endometrial sampling in the high risk woman at the time of menopause. The greatest challenge to primary care physicians may be the early detection of ovarian cancer. No single test is available, nor is any advocated in screening for this lethal disease. Currently, only periodic physical examination is recommended at the cancer checkup interval. Ultrasound, both transabdominal and transvaginal, may help in detecting adnexal masses, but is not sensitive enough to differentiate benign from malignant lesions. In this setting, and in the patient with suspected ovarian cancer, CA 125 and AFP may be helpful in determining which patients require surgical exploration. Women with positive family histories for ovarian cancer require greater vigilance and close follow-up with serial ultrasound and CA 125 determinations. As the population ages, cancer, which is primarily a disease of age, will continue to increase in incidence.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Screening for gynecologic cancer. Vulvar, vaginal, endometrial, and ovarian neoplasms. 141 66

Achievement of NIH and ACS goals for reduction in cancer mortality will require increased efforts directed at risk reduction and early detection in the general population. Primary care providers will play a major role. This paper describes the development and use of a quantitative cancer-risk appraisal tool designed to promote cancer prevention and screening and provide a framework for advancing education on these critical issues at all levels of medical training, to assist physicians in risk identification and patient counseling. The risk assessment questionnaire is close-ended and easily completed by the patient within 10 to 15 minutes. The IBM-compatible format permits easy quantitation by laser scanning and computer analysis. This program quantitates risks arising from interacting independent factors and estimates the effects of primary prevention interventions. Program output includes age- and sex-specific ACS screening guidelines and discussion of intensified screening measures in high-risk subjects.
J Cancer Educ 1992
PMID:A quantitatively scored cancer-risk assessment tool: its development and use. 157 Dec 44

The variability in the published results for colonoscopy and barium enema examinations is confusing. With both, optimum results are dependent on meticulous preparation, technical excellence, and operator proficiency. It is a mistake to place colonoscopy and the barium enema in competitive positions; the two methods ideally complement one another in the evaluation of high risk individuals, including those with positive Hemoccult tests. The exclusion of significant pathology by the double-contrast enema can be relied on and is less costly to the patient. Detection of abnormalities by a barium enema should, when necessary, be followed by colonoscopic verification and/or biopsy. When used in this sequence, the procedures provide a cost-effective approach to the early detection and control of cancer; it is estimated that observance of the ACS guidelines can reduce mortality rates by 30%.
Cancer 1991 Feb 15
PMID:Imaging techniques in the diagnosis of carcinoma of the colon. 199 Dec 73

The American Cancer Society--Duval Unit, in June, 1987, helped organize a community demonstration screening project involving all hospitals and institutions with mammography units in the area. A Northeast Florida Cooperative Breast Cancer Screening Group was formed comprised of physicians and administrators from each institution. A total of 1,200 women agreed to participate in the project and each underwent complete screening including education, instruction in self-examination, physical examination by a physician and mammography as indicated according to ACS guidelines. Of the study group, 1,032 women were eligible for mammography at a participating center, and 628 (61%) underwent a mammogram at no cost to them as instructed. Twenty four (4%) had definite abnormalities which led to biopsy and seven (1%) of them had malignant lesions. The medical community organized to provide breast cancer screening and follow-up with low-cost mammography.
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PMID:Breast Cancer Screening Project in Northeast Florida. 229 24

The survey reported here was undertaken to determine how many people would schedule a sigmoidoscopy after being informed by letter about the American Cancer Society's (ACS's) recommendations for colorectal screening. Letters (1,024) were sent to all patients aged over 50 years who were registered in a community-based family practice residency program. Four hundred twenty-nine responded. Of those who responded, 16.8 percent indicated interest in a rectal examination, 21 percent were interested in testing their stool for occult blood, 13.1 percent desired a sigmoidoscopy, and 11.7 percent indicated that they had previously had a sigmoidoscopy. The following reasons were given by responders who were not interested in sigmoidoscopy: 42 percent felt good and did not perceive a need, 31 percent were concerned about cost, 12.1 percent were concerned about discomfort, and 8.6 percent stated fear as a reason for their response. Of the 56 patients who indicated interest in a sigmoidoscopy, 10 patients had the procedure done (flexible 60-cm sigmoidoscope). Although the ACS recommends that everyone aged over 50 years have a sigmoidoscopy, few patients in this population who responded have had the procedure done. Encouragement and education for patients in colorectal screening, however, is worthwhile. Two colorectal carcinomas were detected as a result of this survey.
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PMID:Patient response to sigmoidoscopy recommendations via mailed reminders. 317 90

Extreme obesity and leanness are risk factors for many types of cancer. An earlier American Cancer Society study (1959-1972) found a nearly twofold increased risk for death from all causes in men and women who weighed 40% or more above average for their age and height, and found elevated cancer rates as well. A new (1982), ongoing ACS prospective study of 1.2 million men and women continues to find increased death rates from all causes and from cancer in the very heavy and the very lean. Artificial sweetener (AS) use is an important correlate of relative weight in this population. The relationship between weight change during the year preceding enrollment and AS usage was studied in a highly homogeneous subgroup of 78694 women ages 50-69 years. The percentage of users increased with body mass index (BMI) and was inversely related to age. Users were significantly more likely than non-users to gain weight, regardless of initial BMI. Among those who gained weight, the average number of lbs gained by AS users was higher (by 0.5-1.5 lb) than the amount gained by non-users. Within the entire cohort, AS users of both sexes ate chicken, fish and vegetables significantly more often than did non-users and consumed beef, butter, white bread, potatoes, ice cream and chocolate significantly less often, suggesting that our weight change results are not explicable by differences in food consumption patterns.
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PMID:Patterns of artificial sweetener use and weight change in an American Cancer Society prospective study. 319 Feb 21

Nearly all cancers, with the exception of lung cancer, are amenable to screening in the primary care office. For many of these tumors, appropriate screening holds greater promise than improved cures for decreasing mortality rates. Screening of asymptomatic patients can be associated with significant costs, both financial and emotional. Excessively rigorous screening efforts can alienate patients from the concept of early diagnosis and may even cause them to avoid seeking other needed medical care. Failure to screen adequately may result in unnecessary loss of life from potentially curable tumors. Because of the complexities involved in carrying out adequate randomized controlled trials of various cancer-screening methods, recommendations must necessarily be based on incomplete information. Although there is room for disagreement among authors and organizations formulating screening plans, the recommendations of the ACS were selected and reproduced in this article. A review of other recommendations is available.
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PMID:Screening and diagnosis of cancer in office practice. 329 22


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