Time trends in Hodgkin's disease incidence: the role of diagnostic accuracy

Article Abstract:

National cancer survey data have indicated an unprecedented decline in the rate of Hodgkin's disease among white Americans over the age of 40. The authors have hypothesized that this difference may not represent an actual decrease in the incidence of the disease, but changes in diagnostic accuracy over the past two decades. The Repository Center for Lymphoma Studies provides a unique resource for evaluating changes in diagnostic accuracy over time. The repository contains both original diagnoses and expert reevaluations for a large number of lymphoma specimens. In reviewing the data, it was found that the accuracy of diagnosis of Hodgkin's disease has improved over time, as might be expected. One consequence of this fact, however, is that Hodgkin's disease was overdiagnosed in the past. Therefore, improved accuracy of diagnosis alone would result in an apparent decrease in the incidence of Hodgkin's disease. Furthermore, the accuracy of diagnosis was found to decrease with the patient's age, and thus improvements in diagnosis are likely to be more noticeable in the incidence figures for older people. A reevaluation of the incidence rates, taking estimated diagnostic errors into account, suggests that the changes in the incidence among older patients may, in fact, be the result of diagnostic errors. However, the review estimated that the increase in Hodgkin's disease among younger people, particularly Hodgkin's disease of the nodular sclerosis type, may actually be greater than previously estimated. The authors provide a detailed breakdown of the incidence of Hodgkin's disease according to different age groups and different disease subtypes. They suggest that the available data are consistent with an unknown infectious cause of Hodgkin's disease, and indicate that the most significant trend in the incidence of Hodgkin's disease is an increase among teenagers and young adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Demographic aspects, Epidemiological research, Cross sectional studies, Epidemiology

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Lymphocyte abnormalities predicting a poor prognosis in Hodgkin's disease: a long-term follow-up

Article Abstract:

The function of lymphocytes, a type of white blood cell, is enormously complex. Detailed analysis of lymphocyte function is generally of interest to researchers trying to understand the workings of the immune system, but is usually of little importance to the clinician treating patients. However, research has now shown that some abnormalities of lymphocyte function which may be revealed in the laboratory may indicate a subset of patients with Hodgkin's lymphoma who are more likely to suffer recurrent disease and death. In a study of 262 patients with Hodgkin's lymphoma, T-cell stimulation by concanavalin A was measured. Concanavalin A is a protein called a lectin, and in laboratory tests it binds to the surface of T lymphocytes and stimulates them to multiply. In 33 percent of the cases, the T cells were more likely to proliferate spontaneously and were less stimulated by the administration of concanavalin A. This property was more common among the patients older than 50 than it was among younger patients. In an analysis of a number of variables, it was found that the most important factors correlating with the outcome of the case were the age of the patient, the stage of the disease, and whether the lymphocyte function measured by this test was normal or abnormal. The 10-year survival rate among the patients with abnormal lymphocyte function was 36 percent. This survival contrasts sharply with the 62 percent 10-year survival which was achieved by the remainder of the patients. The lymphocyte function test is relatively simple to perform, and may prove useful in identifying patients who have a poor prognosis and are thus good candidates for aggressive treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Physiological aspects, Prognosis, T cells

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