Social class as a prognostic factor in breast cancer survival

Article Abstract:

Social class has been shown to affect the likelihood of surviving breast cancer in several countries, including the United States. Many possible reasons for this disparity have been proposed. Lower class people may delay seeking treatment, their treatment may be inferior, or they may be subject to unknown factors which affect the tumor biology. Considering the many possibilities, it is difficult to determine the effect that any single factor might have. A study conducted in Finland has now shed some light on the disturbing class differences in breast cancer mortality. In a retrospective evaluation of 10,181 patients, the researchers found that while the poor and lower class women may be slightly slower at seeking medical advice, the differences in the stage of breast cancer at the time of diagnosis can account for only a small portion of the disparity in mortality. Furthermore, medical treatment in Finland is legislated to be fairly equally accessible to all citizens, regardless of class. Nevertheless, even in Finland, when other confounding factors are stripped away, patients from the lowest social class still had a 1.28 times greater likelihood of dying from breast cancer than those of the highest class. This disparity increases with age, and older patients of the higher classes have an even greater survival advantage over older patients of the lower classes. The cause for this disparity is not known, nor is it known whether the cause is strictly social, e.g. differences in patient compliance among the classes, or whether there is an actual interaction of some sort with tumor biology. The disturbing possibility exists that several factors may be interacting, which will make identification of the cause of the increased mortality among the lowest class especially difficult. Nevertheless, the inequity cannot be tolerated and further effort must be expended to reduce the social class disparity in breast cancer survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social aspects, Patient outcomes, Mortality, Social classes, Social class

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Prognostic significance of the estrogen-regulated protein, cathepsin D, in breast cancer: an immunohistochemical study

Article Abstract:

Breast cancers are sensitive to the hormone estrogen, and many therapeutic regimens take this fact into account. There is much research interest in elucidating the effect that estrogen has on breast cancer cells, and some of this research has identified cathepsin D as a protein which the cells synthesize in greater quantity when stimulated by estrogen. Cathepsin D is a lysosomal protease, which means it is an enzyme that works to digest other proteins within the lysosome, a recycling location where aging and nonfunctional proteins are dissolved and their component parts are returned to the cell for further use. To determine whether cathepsin D may have clinical significance, tissue specimens from 94 cases of operable breast cancer were examined. Staining of the specimens with antibodies to cathepsin D revealed its presence in 62 of 94 patients. There was no significant difference in cathepsin D staining which could be attributed to patient age or menopausal status. Considered overall, staining for cathepsin D was not significantly associated with increased survival time, but when patients whose cells expressed the estrogen receptor were considered separately, the presence of cathepsin D was prognostic for increased survival. The presence of cathepsin D was unrelated to survival among patients without the estrogen receptor on their cancer cells. Cathepsin D was also associated with increased survival among patients with metastases to the lymph nodes. The reason for the association of cathepsin D with improved prognosis is difficult to explain, especially considering that cathepsin D is thought to aid metastatic cells in the invasion of tissues. It may be that the expression of cathepsin D in these tissues is a marker for estrogen receptor function. Further studies should examine the relationship of cathepsin D to the endocrine response, and evaluate it in relation to other tumor markers and prognostic factors. (Consumer Summary produced by Reliance Medical Information, Inc.)

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A population-based study on the incidence and survival rates of 3857 glioma patients diagnosed from 1953 to 1984

Article Abstract:

Many of the published reports in the medical literature describing gliomas and their treatment are either clinical trials or reports of patient series at individual institutions. Few data are available describing the characteristics of cases representing a whole population. In Scandinavia, the tabulation of health data is more centralized than in the United States, and it is possible to evaluate data that are more representative of an entire nation. Medical researchers in Finland now report the results of their review of 3,857 glioma cases diagnosed over a 32-year period. Gliomas are a class representing a variety of primary brain tumors arising from the glial cells of the brain. Of the total number of cases, 200 were of the special type ependymoma arising from the cells lining the fluid filled ventricles of the brain. A total of 191 cases were medulloblastoma, a curious tumor of the cerebellum occurring predominantly in children. The average age for the ependymoma patients was 21.5 years, and the average for the medulloblastoma patients, 12.7 years. The average age for the remaining 3,466 glioma patients was 40.9 years. The one-, 5- and 10-year survival rates were 53 percent, 29 percent, and 20 percent, respectively. Younger patients were more likely to survive than older patients. Over the interval covered by the study, patients diagnosed more recently were found to have better prospects for survival than those diagnosed in the past. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Gliomas, Brain tumors

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