Dissertationen zum Thema „Cancer Age factors“

Prostate cancer is a large and increasing medical problem both in Sweden and in the rest of the developed world, with about 300.000 new cases diagnosed world wide annually. Despite the high incidence of this disease, little is known about the aetiology of prostate cancer. The aim of this study was to try to understand more about the natural history and to find possible a etiological risk factors for this tumour. In a population based study of prostate cancer cases in northern Sweden it was found that the large increase in prostate cancer during the last two decades was mainly caused by well (Gl) and moderately (G2) differentiated tumours. However, the incidence of poorly differentiated (G3) tumours remained unchanged. The introduction of new diagnostic methods is the most plausible explanation for the increase of these low grade tumours. The relative survival in prostate cancer was found to be independent of patient age at diagnosis, indicating that tumour proliferation and the aggressiveness of this disease is equal in all ages. However, due to the increasing occurrence of concurrent diseases with growing age the number of lost years caused by prostate cancer decreases dramatically in older age groups. The overall cause specific mortality for prostate cancer was found to be around 50%. In accordance with most other cancer tumours, the annual mortality rate decreased with longer survival also for prostate cancer patients. In a study from the Swedish Twin Register it was found that the proband concordance rates for prostate cancer were 4,5 time greater among monozygotic compared to dizygotic twins. In a large nation-wide cohort study of men who had a father with prostate cancer, the overall standardised incidence ratio (SIR) was 1.70 for prostate cancer. Younger age at diagnosis among the fathers were associated with an increased risk among sons. This cohort study and the twin study indicates that both inherited and familial factors are of importance in a subgroup of prostate cancer patients. In a prospective case-control study, both a high body mass index (BMI) and a high food intake were found to be independent risk factors for prostate cancer. Both BMI and a high food intake might be indicators of a high fat diet, which so far is the most consistent exogenous risk factor for prostate cancer. The use of tobacco or alcoholic beverages were not associated with prostate cancer risk.

Härtill 5 uppsatser

digitalisering@umu

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.

This final report documents the theoretical development and preliminary empirical testing of a model that predicts the conditions under which Hispanics will seek preventive health care. Research shows that Hispanics delay preventive care, resulting in higher morbidity and mortality rates for serious diseases such as cancer. Since many serious diseases, such as heart disease, diabetes and cancer can be prevented or treated more effectively if detected early, it is crucial to understand the motivating forces behind Hispanics’ preventive health behavior. The Hispanic model, which is an extension of the Health Behavior in Cancer Prevention Model developed by Atwood, et al. (1986), includes as core variables environmental barriers to access and English-language proficiency, as well as social support, health beliefs, self-efficacy (or perceived skill), health locus of control, and health values. This correlational descriptive study employed snowballing sampling methods and consisted of 199 Hispanics between 49 and 94 years of age. Measures consist of multi-item scales whose content follows that of the Parent Project. The final instruments showed reliability (Alphas between .69 and .95), although the model testing was limited by the exclusion of some constructs that did not demonstrate reliability. The outcome of predisposition to self-care was predicted by utilization barriers to care, Chance Health Locus of Control, and General Health threat, resulting in an R-square of .07. The findings dealing with dietary preferences and preferred dietary modifications also have great implications for interventions aimed at preventing colon cancer among Hispanics. The practical health policy applications of the model are also discussed.

Reprints of the author's previously published articles included as an appendix. Bibliography: leaves 165-188. "This thesis describes a series of experiments that aimed to investigate the effects of folic acid deficiency and defects in folate metabolism on chromosome damage rates in human lymphocytes. The accumulation of chromosome damage over time is an important issue because it is thought to contribute to the mechanism of ageing and the aetiology of diseases of age such as cancer and Alzheimer's disease."

Health beliefs of 221 postmenopausal women were assessed to predict the Breast Cancer Screening Behaviors of breast self-examination (BSE) and utilization of mammography. Champion's (1991) revised Health Belief Model (HBM) instrument for BSE, which assesses the HBM constructs of Seriousness, Susceptibility, Benefits, Barriers, Confidence and Health Motivation, was utilized along with her Barriers and Benefits instrument for mammography usage. Ronis' and Harel's (1989) constructs of Severity-Late and Severity-Early were evaluated along with Cuing and demographic variables. These exogenous latent constructs were utilized in a LISREL path model to predict Breast Cancer Screening Behavior.

Background The debate regarding the lower age limit for mammography service screening is old and lively; a product in part of the lower breast cancer risk in younger ages as well as the limited data available for studies of the younger age group. Recently the idea of inviting only high risk groups has gained momentum, however high risk might not be equivalent to greater benefit from screening. Therefore, there is a need for information on effectiveness of screening as it relates to young women and to specific risk groups. To this end, this thesis evaluates mammography screening for the age group – 40 to 49 year old women – in terms of breast cancer mortality reduction in total and in subgroups based on breast cancer risk factors. Overdiagnosis of mammography screening is also evaluated for women 40 to 49 years old. In addition, this thesis presents a statistical method to estimate this effectiveness and to test for differences in effectiveness between subgroups adjusted for non-compliance and contamination. Methods The studies of this thesis are based on data from the Screening of Young Women (SCRY) database. The SCRY database consists of detailed information on diagnosis, death, screening exposure and risk factors for breast cancer cases and population size by year (between 1986 and 2005) and municipality for women in Sweden between 40 and 49 years old. The material was divided into a study group consisting of the counties that invited women in the age group 40-49 years to mammography screening, and a contemporaneous control group consisting of the counties that did not. Effectiveness was estimated in terms of rate ratios for two different exposures (invitation to and participation in screening), and overdiagnosis for subsequent screening was estimated adjusting for lead time bias. Defining a reference period enabled adjustment for possible underlying differences in breast cancer mortality and incidence. A statistical model for adjusting for non-compliance and contamination in randomised controlled trials was further developed to allow for adjustment in cohort studies using a Poisson model with log-linear structure for exposure and background risk. Results During the study period (1986-2005), there were 619 and 1205 breast cancer deaths and 6047 and 7790 breast cancer cases in the study group and the control groups, respectively. For women between 40 and 49 years old, the breast cancer mortality reduction was estimated at 26% [95% CI, 17 to 34%] for invited to screening and 29% [95% CI, 20 to 38%] for attending screening. The RR estimates for the high-risk groups based on the risk factors parity, age at birth of first child, and socio-economic status were equal to or higher than that of the low risk groups. The new statistical method showed that the decrease in effectiveness with parity was not a statistically significant trend. The overdiagnosis from subsequent screening for 40 to 49 year old women was estimated at 1% [95 % CI, -6 to 8 %] (i.e., not statistically significant). Conclusion Subgroup specific effectiveness was also estimated. The relative effectiveness of screening for breast cancer with mammography for women age 40 to 49 years appears to be comparable to that for older women. These findings and the fact that there was no statistically significant overdiagnosis from subsequent screening speak for inviting women 40 to 49 years old to screening. High-risk screening for nulliparous women aged 40 to 49 years, for example, might be an alternative in countries where population-based screening for all women between 40 and 49 years old is not possible. However, the matter of risk factors and the effect of their combinations is complex and risk group screening presents ethical and practical difficulties. The new statistical model is a useful tool for analysing cohorts with exposed and non-exposed populations where non-compliance and contamination is a potential source of bias.

Objective: Insulin-like growth factor-I (IGF-I) has been suggested to be a prognostic marker for the development of cancer and, more recently, cardiovascular disease. These diseases are closely linked to obesity, but reports of the association of IGF-I with measures of obesity are divergent. In this study, we assessed the association of age-dependent IGF-I standard deviation scores with body mass index (BMI) and intra-abdominal fat accumulation in a large population. Design: A cross-sectional, epidemiological study. Methods: IGF-I levels were measured with an automated chemiluminescence assay system in 6282 patients from the DETECT study. Weight, height, and waist and hip circumference were measured according to the written instructions. Standard deviation scores (SDS), correcting IGF-I levels for age, were calculated and were used for further analyses. Results: An inverse U-shaped association of IGF-I SDS with BMI, waist circumference, and the ratio of waist circumference to height was found. BMI was positively associated with IGF-I SDS in normal weight subjects, and negatively associated in obese subjects. The highest mean IGF-I SDS were seen at a BMI of 22.5–25 kg/m2 in men (+0.08), and at a BMI of 27.5–30 kg/m2 in women (+0.21). Multiple linear regression models, controlling for different diseases, medications and risk conditions, revealed a significant negative association of BMI with IGF-I SDS. BMI contributed most to the additional explained variance to the other health conditions. Conclusions: IGF-I standard deviation scores are decreased in obesity and underweight subjects. These interactions should be taken into account when analyzing the association of IGF-I with diseases and risk conditions.

Objective: Insulin-like growth factor-I (IGF-I) has been suggested to be a prognostic marker for the development of cancer and, more recently, cardiovascular disease. These diseases are closely linked to obesity, but reports of the association of IGF-I with measures of obesity are divergent. In this study, we assessed the association of age-dependent IGF-I standard deviation scores with body mass index (BMI) and intra-abdominal fat accumulation in a large population. Design: A cross-sectional, epidemiological study. Methods: IGF-I levels were measured with an automated chemiluminescence assay system in 6282 patients from the DETECT study. Weight, height, and waist and hip circumference were measured according to the written instructions. Standard deviation scores (SDS), correcting IGF-I levels for age, were calculated and were used for further analyses. Results: An inverse U-shaped association of IGF-I SDS with BMI, waist circumference, and the ratio of waist circumference to height was found. BMI was positively associated with IGF-I SDS in normal weight subjects, and negatively associated in obese subjects. The highest mean IGF-I SDS were seen at a BMI of 22.5–25 kg/m2 in men (+0.08), and at a BMI of 27.5–30 kg/m2 in women (+0.21). Multiple linear regression models, controlling for different diseases, medications and risk conditions, revealed a significant negative association of BMI with IGF-I SDS. BMI contributed most to the additional explained variance to the other health conditions. Conclusions: IGF-I standard deviation scores are decreased in obesity and underweight subjects. These interactions should be taken into account when analyzing the association of IGF-I with diseases and risk conditions.

Philosophiae Doctor - PhD
Background Overweight/obesity is a risk factor for non-communicable diseases such as cardiovascular diseases, diabetes, and some cancers. Obesity in childhood is known to predict later obesity in adolescence and adulthood. Understanding the factors associated with overweight/obesity among children may present an opportunity for timely and appropriate interventions in the African setting. Aims 1. To describe the prevalence of overweight and obesity and associated factors among school children aged 8 - 11 years in primary schools in Adentan Municipality, Ghana. 2. To review the available literature on childhood obesity in the African context to provide evidence to support the design and improvement of appropriate school-based interventions for the prevention and control of overweight/obesity among African learners. Methodology This was a cross-sectional study design which was conducted in two phases. In Phase I, the available literature on the prevalence of overweight and obesity among learners, school-based interventions to promote healthy nutrition and physical activity (PA), and weight status, and key policy interventions at the national levels to provide supportive environments in the African context was reviewed and synthesised. In Phase II, interviews were conducted to collect individual and family data from 543 learners in 14 schools to assess family socio-demographics characteristics, dietary, PA, and sedentary behaviours, and sleep duration. Body weight, height, and waist circumference were measured. Data on perceived school neighbourhood/ community, school food, and PA environments were collected from school heads/administrators. A sub-sample of 183 children participated in the assessment of body fat using the deuterium dilution method. Multivariable and logistic regressions, multilevel logistic regressions, and multilevel linear regression models were used to examine the associations among child, family, and school level explanatory variables, and overweight/obesity, abdominal obesity and body mass index (BMI). Results The reviews revealed the following: (i) The pooled overweight and obesity estimates across Africa were: (10.5% 95% CI: 7.1-14.3) and 6.1% (3.4-9.7) by World Health Organization; 9.5% (6.5-13.0) and 4.0% (2.5-5.9) by International Obesity Task Force; and 11.5% (9.6-13.4) and 6.9% (5.0-9.0) by Centers for Disease Control and Prevention, respectively and differed for overweight (p=0.0027) and obesity (p<0.0001) by the criteria. The estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year, and sample size; (ii) Although inconsistent, school-based interventions broadly improved weight status and some energy-balance related health behaviours of African learners; (iii) On applying the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, key interventions on unhealthy diets and physical inactivity targeted the school, family and community settings, and macro environments, and broadly aligned with global recommendations. In the school-based study, 16.4% of Ghanaian learners were overweight (9.2%) or obese (7.2%), with the prevalence being significantly higher in children from middle- to high socio-economic status (SES) households, and private schools. In multivariable regression models, attending private school (AOR = 2.44, 1.39–4.29) and excessive television viewing (AOR = 1.72, 1.05–2.82) significantly increased the likelihood of overweight/obesity, whereas adequate sleep (AOR = 0.53, 0.31–0.88), and active transport to and from school (AOR = 0.51, 0.31 – 0.82) decreased the odds. Using deuterium-derived percent body fat as criterion method, the published BMI criteria was found to be highly specific but with moderate sensitivity for diagnosing obesity among Ghanaian children. Moreover, the BMI-for-age z-scores that optimise sensitivity, specificity, and predictive values for obesity were lower than the published cut-off points. Multilevel logistic and linear regression analyses revealed that the school contextual level contributed 30.0%, 20.6% and 19.7% of the total variance observed in overweight (including obesity), abdominal obesity, and BMI respectively. Availability of school cafeteria (β = 1.83, p = 0.017) and shops (β = 2.34, p = 0.001), healthy foods (β = 0.77, p = 0.046), less healthy foods (β = 0.38, p = 0.048), child age (β = 0.40, p = 0.008), school-level SES (β = 1.02, p < 0.0001), private school attendance (β = -1.80, p = 0.006), and after-school recreational facilities (β = 0.89, p < 0.0001) were all associated with BMI. In the mutually adjusted models for all significant predictors, school-level SES, healthy foods, after-school recreational facilities, and PA facility index remained significant predictors of overweight and or abdominal obesity. Conclusions The prevalence of overweight/obesity is significantly higher in urban children attending private or high SES schools, regardless of criteria used to define obesity. A number of individual, family, and school-level factors significantly predicted weight status of school children in Ghana. Given that many African governments have initiated policy interventions aiming to provide supportive environments for healthy choices, it is recommended that resources are made readily available for the implementation of these interventions across the home, school and community.

The study is informed by inadequate information on factors associated with the prevalence, incidence and mortality of cervical cancer cytological abnormalities in Swaziland. The aim of the study was to explore and describe factors associated with cervical cancer among women of reproductive age between 15 and 49 years in Swaziland. Quantitative descriptive design with a data extraction tool was used to retrospectively generate observational data from 1748 patients’ records in Mbabane Government Hospital from January 2014 through to December 2014. Bivariate logistic regression was used to establish relationship between cervical cancer and each explanatory variable. The overall prevalence of cervical cytology test results was 24.9%. The combination of marital status, HIV status, ART status, age at sexual debut have been identified as factors associated with cervical abnormalities. Most importantly, the results will also serve as evidence for the development of a national cervical cancer screening policy and also strengthening the cancer registry in Swaziland.
Health Studies
M.A. (Public Health)

碩士
國立臺灣大學
公共衛生碩士學位學程
105
The incidence rate of breast cancer was increasing year by year. According to the CANCER REGISTRY ANNUAL REPORT published in 2016, breast cancer accounts for the first place in top 10 cancer incidence (including carcinoma in situ) and the fourth place of mortality. In Taiwan, most of the age of breast cancer is between 45 and 59 years old. In addition, young patients with breast cancer (breast cancer diagnosed younger then 45 years old) is increasing gradually, different from the feature in Western countries. Therefore, this study aims to assess possible associative factors for quality of life after surgery among breast cancer survivors of different age groups. This was a cross-sectional study. Subjects are the breast cancer patients of breast surgery clinic in Taipei Medical University Hospital, Taipei Municipal Wanfang Hospital, and Taipei Medical University Shuang Ho Hospital. We used EORTC QLQ-C30, EORTC QLQ-BR23 and FACT-B to evaluate the patient’s QoL. Besides, we also collected demographic variables (age, the first breast cancer diagnosis age, marital status, and education), economical resource, medical history, lifestyle habits, menstrual history and pregnancy history with structured questionnaire. Clinical and pathological information were obtained by well-trained researchers from hospital system. The data were analyzed by descriptive statistics, univariate analyses, and stepwise regression. There were 116 subjects with collection period from August 1st, 2015 to February 28, 2017. All subjects were divided into two groups, young patients with breast cancer (the first breast cancer diagnosis age<45 years old, n=50) and elderly patients with breast cancer (the first breast cancer diagnosis age≧45 years old, n=66). The major findings of this study as follows：(1) For patients in both groups, there are several variables had different effects on the quality of life. First, young patients whose family annual income higher than 1.5 million had lower impact on global health status (QL2), whereas the elderly patients had a positive impact on QL2. Second, on the domain of sexual enjoyment (BRSEE), young breast cancer patients who have a partner had a negative impact on BRSEE, whereas the elderly patients had a positive impact on it. Third, elderly patients with breast cancer who received hormonal therapy had a negative impact on the domain of role functioning (RF2). Forth, there was a high acceptability of breast preserving surgery in young patients and a high acceptability of modified radical mastectomy in elderly patients. (2) For patients in both groups, the impacts of several variables on quality of life were consistent. First, patients who were in employment had a lower QoL than housekeepers. Second, patients who had chronic disease history had negative impact on quality of life, especially for elderdy patients. Third, patients with lymphatic metastasis whose arm edema increased, and thus make work or leisure and entertainment activities affected. Forth, the impacts of chemotherapy on the different domains of quality of life were most obvious. In general, elderly patients, housekeepers, the early stage of breast cancer and patients with high social support had positive impacts on QoL. Patients in both groups undergoing chemotherapy had negative impacts on most domains. On the domain of upset by hair loss (BRHL), young patients had a negative impact on it, however, we didn’t observe the same result in the elderly group. In conclusion, the effect of chemotherapy on quality of life of different breast cancer age groups is most pronounced and negative in all adjuvant therapy. Receiving mastectomy, having lymph node metastasis, later stage of cancer had negative impact on QoL in young breast cancer patients. In clinical care, in addition to the existing resources, we should provide psychological counseling or set up a patient support group of similar ages to provide more appropriate care to different age groups of breast cancer patients.

Reprints of the author's previously published articles included as an appendix.
Bibliography: leaves 165-188.
xiv, 189 leaves : ill. (some col.) ; 30 cm.
"This thesis describes a series of experiments that aimed to investigate the effects of folic acid deficiency and defects in folate metabolism on chromosome damage rates in human lymphocytes. The accumulation of chromosome damage over time is an important issue because it is thought to contribute to the mechanism of ageing and the aetiology of diseases of age such as cancer and Alzheimer's disease."
Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 2002?

碩士
國立中山大學
企業管理學系醫務管理碩士班
106
Objective: Cancer has been the top ten leading cause of death in Taiwan in the past 30 years. Moreover, the colorectal cancer morbidity and mortality rates have both shown an increasing trend. Related research has pointed out that fecal occult blood test (FOBT) can reduce morbidity and mortality of colorectal cancer. However, the FOBT rate in Taiwan has not been able to achieve national goals. The purpose of this study is to investigate factors associated with FOBT uptake among middle-aged and old people in southern Taiwan. Methods: The present study reviews the related literature and applies the Health Belief Model in designing a structural questionnaire. Survey data were collected from a random sample comprising 340 adults aged 50-74. These respondents were assessed by the author through the internet and in communities in southern Taiwan. Methods used for analysis include descriptive statistics, chi-square test, independent sample t-test, and logistic regression analysis. Results: The results show that age, having an adult health check-up, and having cervical cancer screening were all significantly correlated with FOBT uptake. 74.7% respondents had actually undergone FOBT before, and 52.6% respondents had a routine FOBT within the past 2 years. Logistic regression analysis shows that the perceived barriers to preventive action were negatively correlated with FOBT uptake. Conclusion: Around 25% respondents have never had FOBT and nearly half of the respondents do not have regular colorectal cancer screening. On the basis of findings from the present study, we recommend that the government and hospitals advocate the benefits of FOBT to people who are at younger ages, who have greater barrier to cancer screening, and who never had an adult health check-up and cervical cancer screening. In addition, to achieve the policy goal that an eligible resident should receive a FOBT every two years, health authorities may consider developing health policies for raising the awareness of and reducing barriers to colorectal cancer screening.

碩士
亞洲大學
長期照護研究所
96
According to statistics from the Department of Health, malignant tumor has been the top ten leading causes of death for more than 30 years and prostate cancer is the sixth highest in incidence rate and seventh in mortality rate for male cancers in Taiwan. Early detection is the key for treating cancer. The purpose of this study is to investigate factors related to participating in prostate cancer screening among community-dwelling adults aged 45 and over in central Taiwan. 　　The subjects of study were from participants of free prostate cancer screening activities were held in Oct and Dec 2007 and scheduled another 6 days to survey. Totally 208 questionnaires had been completed that included 107 participators and 101 non-participators of the free screening. The data were analyzed with descriptive statistics, Chi-square test, one-way ANOVA and logistic regression. Logistic regression analysis was used to explore the potential predictors of participating in a free screening, including demographics and four constructs of the health belief model. 　　The results of the study were as following: (1)The average age of this sample of elders was 74. Most of them had religious belief, paid much attention to healthy status, had no job, not lived alone, knew purpose of prostate cancer screen, knew PSA test was a method of screen and knew PSA normal ranges. (2)When asked why they participated in the free screening, the poster of screen advertising came first. Heard from relatives and friends was the second. (3)The difference between perceived susceptibility, perceived severity and perceived benefits(p<.001) correlated with participating in prostate cancer screening. (4)The majority of the participtors scored higher in healthy belief when compared to the non-participtors. (5)Logistic regression models indicate that not lived alone, knew purpose of prostate cancer screen and perceived susceptibility were significant predictors of participating in prostate cancer screening. 　　The findings of the study will provide public health officials crucial information for developing future screening programs. In order to enhancing people’s motives to disease screening, this study suggests that prostate cancer screening can be covered by the national health program and using media to propagate the knowledge of prostate cancer and screening method are important strategies in promoting prostate cancer screening. Key words：Prostate Cancer Screen, Health Belief Model