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Cost-effective mammography screening in Korea: High incidence of breast cancer in young women (vol 100, pg 1105, 2009)
Cancer Science
Purpose:
Mammography has been confirmed as the only effective mode to improve the prognosis of patients with breast cancer in Western developed countries, but might not be a good choice in other areas of the world. One of the major challenges in China is to determine an optimal imaging modality for breast cancer screening. This study was designed to clarify the sensitivity of ultrasonography compared with that of mammography in rural China.
Methods:
We retrospectively studied the sensitivity of mammography and ultrasonography based on 306 breast cancer patients detected by the program of "screening for cervical cancer and breast cancer" performed in Chinese rural areas between January 2009 and December 2011, and analyzed the effects of age, breast density and volume on the sensitivity.
Results:
Stratified analysis showed that the sensitivity of breast ultrasonography was significantly higher than that of mammography in premenopausal patients (81.4% vs. 61.1%, p=0.02), in women ≤ 55 years of age (82.2% vs. 63.4%, p<0.01), in the high breast density group (American College of Radiology [ACR] levels 3-4) (85.9% vs. 60.6%, p<0.01) and in the small breast volume group (≤ 400 ml) (87.1% vs. 66.7%, p<0.01). Age had a significant effect on sensitivity of mammography (breast density and volume-adjusted odds ratio, 6.39; 95% confidence interval, 2.8-14.4 in age group > 55 compared to age group ≤ 45), but not that of ultrasonography. Neither breast density nor volume had significant effect on sensitivity of mammography or ultrasonography.
Conclusions:
Ultrasonography is more sensitive than mammography in detecting breast cancer in women under 55 year-old Chinese, especially in those with high-density and relatively small breasts.
The association between schizophrenia and cancer risks is controversial in the clinical and epidemiological literature. Studies from different populations, tumor sites, or health care systems have provided inconsistent findings. In the present study, we examine a less well-investigated hypothesis that age plays a crucial role in cancer risks in schizophrenia. We conduct a nationwide cohort study using Taiwan's National Health Insurance Research Database (NHIRD) between 1995 and 2007. Overall, gender-, and age-stratified standardized incidence ratios (SIR) were used to investigate the pattern of cancer risks by age. Among the 102,202 schizophrenia patients, 1,738 developed cancers after diagnosis of schizophrenia (SIR=0.92, 95% CI: 0.90-0.96). However, the age-stratified SIRs declined with age (for example, age 20-29, SIR=1.97, 95% CI: 1.85-2.33; age 60-69, SIR=0.68, 95% CI: 0.65-0.78; age≥70, SIR=0.36, 95% CI: 0.34-0.45) in both genders and for major cancers. Cancer risks in schizophrenia patients were lower in the cancers that are more likely to develop at older age in the general population, such as stomach cancer (SIR=0.62, 95% CI: 0.57-0.80), pancreas cancer (SIR=0.49, 95% CI: 0.39-0.84) and prostate cancer (SIR=0.35, 95% CI: 0.29-0.58). By contrast, cancer risks were higher in the cancers that have a younger onset age, such as cancers of nasopharynx (SIR=1.18, 95% CI: 1.08-1.49), breast (SIR=1.50, 95% CI: 1.44-1.66) and uterine corpus (SIR=2.15, 95% CI: 1.98-2.74). Schizophrenia populations' unique age structures and early aging potential might contribute to the observed inverse relationship between age and cancer risks. Higher cancer comorbidity in young schizophrenia patients deserves more attention.
Bile acids and bile alcohols in the form of their conjugates are amphipathic end products of cholesterol metabolism with multiple physiological functions. The great variety of bile acids and bile alcohols that are present in vertebrates are tabulated. Bile salts have an enterohepatic circulation resulting from efficient vectorial transport of bile salts through the hepatocyte and the ileal enterocyte; such transport leads to the accumulation of a pool of bile salts that cycles between the liver and intestine. Bile salt anions promote lipid absorption, enhance tryptic cleavage of dietary proteins, and have antimicrobial effects. Bile salts are signaling molecules, activating nuclear receptors in the hepatocyte and ileal enterocyte, as well as an increasing number of G-protein coupled receptors. Bile acids are used therapeutically to correct deficiency states, to decrease the cholesterol saturation of bile, or to decrease the cytotoxicity of retained bile acids in cholestatic liver disease.