原发性高血压遗传流行病学研究

目的探讨原发性高血压的遗传模式。方法对117个原发性高血压家系用分离分析法和多基因阈值理论进行遗传模式的研究。结果常染色体显性遗传和隐性遗传模式的统计学检验均具有显著意义（P〈0.05）;资料中子女高血压发病情况分析显示,此病不符合性连锁遗传方式;多基因阈值分析的遗传率为74.83%。结论原发性高血压为多基因遗传疾病,平均遗传度为74.83%±4.28%,对有遗传易感性人群应重点管理,加强防治。     

家族性乳腺癌遗传易感基因研究现状

家族性乳腺癌与遗传易感基因的突变有密切的联系，目前已发现多种乳腺癌遗传易感基因，它们分别定位于１７号和１３号染色体的长臂和８号染色体的短臂上。乳腺癌家族中易感基因突变携带患乳腺癌的危险性明显高于普通人群，具有不同易感基因突变的乳腺癌患其组织学特征也有所不同。本就家族性乳腺癌遗传易感基因的研究进展作一综述。     

家族性乳腺癌遗传易感基因研究现状

家族性乳腺癌与遗传易感基因的突变有密切的联系 ,目前已发现多种乳腺癌遗传易感基因 ,它们分别定位于 17号和 13号染色体的长臂和 8号染色体的短臂上。乳腺癌家族中易感基因突变携带者患乳腺癌的危险性明显高于普通人群 ,具有不同易感基因突变的乳腺癌患者其组织学特征也有所不同。本文就家族性乳腺癌遗传易感基因的研究进展作一综述     

偏头痛的遗传流行病学研究进展

偏头痛的患病率较高，但临床就诊率不高。国内对于偏头痛的研究往往局限于诊断、治疗、药理等方面，遗传学方面的研究几乎是空白。为提高大家对偏头痛遗传学方面的认识，本文对近年有关偏头痛遗传模式、遗传基础及遗传与环境交互作用的研究进展进行了综述。     

CDT1和GMNN基因多态性与女性乳腺癌危险性的关联研究

目的探讨参与DNA复制的两个重要基因CDTI和GMNN基因多态性与我国人群散发乳腺癌的关联。方法采用病例对照研究设计，研究对象包括427例乳腺癌患者及477名无肿瘤史的正常对照组。采用聚合酶链反应-限制性片段长度多态性，方法测定CDT 1838G／A，错配聚合酶链反应-限制性片段长度多态性方法测定GMNN 387C／A的基因型。结果CDT1GG、GA和AA3种基因型以及GMNN CC、CA和从3种基因型在病例组和对照组的频率分布差异无统计学意义（P值分别为0．619和0．793）。然而，分层分析发现，在有肿瘤家族史的人群中，CDT1 GA＋AA基因型可显著增加乳腺癌的危险性（调整OR：2．21，95％CI：1．20～4．09）。结论CDT1 838G／A基因多态性和GMNN 387C／A基因多态性与总的散发性乳腺癌无显著关联，但CDT 1838G／A可能对于具有遗传背景的女性乳腺癌的易感性具有一定的作用。     

病理性近视眼的遗传流行病学研究

目的 对上海市眼耳鼻喉科医院病理性近视眼患者６２个家系的遗传方式进行研究,探讨可能的遗传模式。方法 用ＳＥＧＲＡＮＢ软件进行简单分离分析,计算确认概率π,并在此基础上计算分离比ｐ和散发概率ｘ,用ＳＡＧＥ－ＲＥＧＤ软件进行复合分离分析,探讨可能的遗传模式和致病基因概率。结果 婚配类型为Ｎ＊Ｎ的家系表现为常染色体隐性遗传,Ａ＊Ｎ婚配类型则可能为隐性遗传模式（不能排除显性遗传模式）,两种婚配类型中均在一     

儿童支气管哮喘遗传流行病学研究

儿童支气管哮喘遗传流行病学研究张玲，官茹明，魏治文，江忠支气管哮喘（哮喘）是儿童时期常见的慢性呼吸道变态反应性疾病，严重危害儿童的发育和身心健康。国内用遗传流行病学的方法研究儿童哮喘的文献报道较少。我们于１９９０年２～８月对青岛市０～１４岁儿童进行了...     

Disparities in female breast cancer mortality rates in Brazil between 1980 and 2009

OBJECTIVE:

To describe the temporal trends in female breast cancer mortality rates in Brazil in its macro-regions and states between 1980 and 2009.

METHODS:

This was an ecological time-series study using data on breast cancer deaths registered in the Mortality Data System (SIM/WHO) and census data on the resident population collected by the Brazilian Institute of Geography and Statistics (IBGE/WHO). Joinpoint regression analyses were used to identify the significant changes in trends and to estimate the annual percentage change (APC) in mortality rates.

RESULTS:

Female breast cancer mortality rates in Brazil tended to stabilize from 1994 onward (APC = 0.4%). Considering the Brazilian macro-regions, the annual mortality rates decreased in the Southeast, stabilized in the South and increased in the Northeast, North, and Midwest. Only the states of Sao Paulo (APC = -1.9%), Rio Grande do Sul (APC = -0.8%) and Rio de Janeiro (APC = -0.6%) presented a significant decline in mortality rates. The greatest increases were found in Maranhao (APC = 12%), Paraiba (APC = 11.9%), and Piaui (APC = 10.9%).

CONCLUSION:

Although there has been a trend toward stabilization in female breast cancer mortality rates in Brazil, when the mortality rate of each macro-region and state is analyzed individually, considerable inequalities are found, with rate decline or stabilization in states with higher socioeconomic levels and a substantial increase in those with lower socioeconomic levels.     

Genetic epidemiology of early onset breast cancer.

Risks for breast cancer when there is a family history of the disease are usually calculated using data from segregation analyses which favour a single dominant gene with high penetrance. There are, however, at least three loci known to be associated with familial breast cancer (p53, BRCA1, and an as yet unpublished locus) and the frequencies and penetrances of these genes are not likely to be the same. We have attempted to address the problem of which genetic parameters should be used to calculate risks for different patterns of familial breast cancer. Data from 384 nuclear families ascertained through a proband selected for early onset breast cancer were subjected to complex segregation analysis, correcting for ascertainment bias resulting from selection for severe phenotype. Age of onset of breast cancer, incorporated as severity, provides additional information to the segregation model over and above that given by assigning liability classes on the basis of age at observation. The use of this additional parameter in the analysis is described. There is fair agreement between estimates from this sample and previous predictions from consecutive probands and consultands. The differences suggest more than one rare dominant gene for susceptibility to breast cancer, with different penetrances. Although refinements of segregation analysis will help to delineate these different genes, perfect resolution will require identification of the mutant alleles. Methods to estimate genetic parameters under genotype specific mortality need to be developed. Meanwhile, we suggest that high and low estimates of penetrance be used in risk estimation for genetic counselling, and as a guide to candidates for entry into clinical trials of screening and chemoprevention in breast cancer.     

Genetic epidemiology of breast cancer in Britain

A complex segregation analysis was conducted on two British series (one consecutive series of probands with breast cancer and one series ascertained through a normal consultand). Altogether there were 1248 nuclear families with breast cancer. A dominant gene with a frequency of 0-003 giving a lifetime penetrance of 0-83 is favoured. Ovarian, endometrial and cancers associated with the SBLA syndrome, as well as benign breast disease, were significantly more common in familial breast cancer than in families of single cases. Probands in families with more than one individual with breast cancer were non-significantly younger than isolated probands.     

99mTc-thymine scintigraphy may be a promising method in the diagnosis of breast cancer

OBJECTIVE:

Mammography has been established as the gold standard for the detection of breast cancer, and imaging techniques such as ultrasonography, magnetic resonance imaging, scintigraphy and positron emission tomography may be useful to improve its sensitivity and specificity. The objective of this study with breast scintigraphy was to evaluate the uptake of 99mTc-thymine in mammary lesions.

METHODS:

A total of 45 patients were included in this study. Thirty-three patients (73%) were subjected to surgery or percutaneous biopsy, providing histopathological data. The other 12 patients who remained under surveillance received clinical examinations and biannual mammography with a normal follow-up of at least three years, the data from which were used for comparison with the scintimammography results.

RESULTS:

The majority of patients (64.4%) had clinically impalpable lesions with a mammogram diagnosis of microcalcifications, impalpable nodules, or focal asymmetry. Of the studied lesions, 87% were smaller or equal to 20 mm in diameter, and 22% had malignant histopathological findings. Scintigraphy with 99mTc-thymine had a sensitivity of 70%, a specificity of 85.7%, positive and negative predictive values of 58.3% and 90.9%, respectively, and an accuracy of 82.2%.

CONCLUSIONS:

The results of this study are consistent with those previously reported by other authors. The good specificity and high negative predictive value of this technique and the absence of uptake in the heart indicate that it may be a promising complementary method in clinical practice and that it may contribute to reducing unnecessary benign biopsies.     

A feasibility study to evaluate breast cancer patients’ knowledge of their diagnosis and treatment

Objective

To evaluate the feasibility of an electronic survey to assess patients’ knowledge of their breast cancer and treatment, and interest in receiving a medical summary.

Methods

Women undergoing breast cancer treatment completed an interviewer-administered electronic survey in person or by telephone. Medical records were abstracted to evaluate knowledge accuracy.

Results

Among 38 eligible patients approached for the study, 35 (92%) participated and 33 (94%) completed the survey. Participants’ perceived knowledge tended to be greater than their actual knowledge. Reporting of clinicopathologic features was most accurate for stage (91%) and lymph node status (88%), and least accurate for tumor size (61%), type (61%), and grade (33%). Accurate reporting of tumor receptor over-expression varied from 76% (estrogen receptor) to 39% (progesterone receptor). Many patients correctly recalled general treatment modalities and details of surgery; fewer recalled details of radiation and chemotherapy. Importantly, nearly all (32/33) were interested in receiving a breast cancer medical summary.

Conclusion

An electronic survey is feasible to assess breast cancer patients’ knowledge. This data suggest that patients have gaps in knowledge and would like a personalized medical summary.

Practice implications

Larger studies are needed to validate and characterize knowledge gaps, and test interventions to improve physician–patient information sharing.     

Oral health after breast cancer treatment in postmenopausal women

OBJECTIVE:

Oral health can affect a patient''s general health and quality of life. Given the increase in breast cancer survival rates, investigations of factors influencing the quality of life of survivors have gained importance. Therefore, the objective of our study was to characterize oral health in postmenopausal breast cancer survivors.

METHODS:

We conducted a matched case-control study. Forty-eight women who survived breast cancer (age 62.1±9.1 years) and 48 healthy controls (age 61.8±8.6 years) were included. For each case and control, a complete oral evaluation chart was completed.

RESULTS:

The prevalence of chronic periodontal disease was 98% in breast cancer survivors and 87% in controls. The breast cancer survivors had a median of 16 remaining teeth, whereas controls had a median of 22 remaining teeth (p = 0.03). The percentage of sites with gingival bleeding was 16.05% (0-100%) in breast cancer survivors and 0% (0-72%) in controls (p = 0.04).

CONCLUSION:

Chronic periodontal disease and tooth loss were highly prevalent in postmenopausal breast cancer survivors. To improve survivors'' quality of life, a preventive oral health evaluation should be available prior to cancer treatment.     

A computer model for the study of breast cancer

A computer model was designed as a relational database to assess breast cancer screening in a cohort of women where the growth and development of breast cancer originates with the first malignant cell. The concepts of thresholds for growth, axillary spread, and distant sites are integrated. With tumor diagnosis, staging was performed that includes clinical and sub-clinical states. The model was parameterized to have staging characteristics similar to data published by the Surveillance, Epidemiology, and End-Results (SEER) Program. Validation was accomplished by comparing simulated staging results with non-SEER sources, and simulated survival with independent clinical survival data.     

Diagnosis analysis in breast cancer and cervical cancer screening

Assessment of the accuracy of diagnostic procedures has been made independent of the diagnostic criteria used by means of Relative Operating Characteristics (ROC) analysis. A ROC curve describes the mutual relationship between the sensitivity and specificity of a diagnostic decision on the basis of various diagnostic criteria. The construction of such ROC curves is made possible if diagnoses are graded into levels of certainty. The curve enables the choice of an operating point with predetermined sensitivity and specificity values for the diagnosis decision. The population-based breast-cancer and cervical cancer screening projects carried out in Utrecht demonstrated an excellent fit between actual data and the calculated ROC curves. Analysis of the accuracy or performance of cytological diagnosis uncovered a problem arising from the similarly graded histopathological reference criteria used to determine the 'truth' of the cytological diagnosis decisions. The proposed solution is a serial calculation of ROC curves, one for each level differentiating between the histopathological categories. The ensuing three-dimensional ROC hill may reveal a summit marking numerically advantageous diagnosis criterion levels for both the test and the disease to be detected, or a depression signalling locally below-standard detection performance.     

The effect of tissue fixation and processing on breast cancer size

Precise measurement of an invasive breast cancer is crucial for pathological staging and subsequent patient management. Formalin fixation and histological processing may change tissue size, but there is no agreement on which state of the specimen, fresh or fixed, should be used for final tumor measurement. To determine the influence of fixation and processing on breast tumor size, a specific 1-dimensional measurement from 50 invasive breast tumors was recorded in fresh, fixed, and processed/mounted states. Tumors varied in maximum measured dimension from 4 to 20 mm and contained 10% to 90% estimated fibrous tissue (mean, 52.8%). In 96% of cases, there was no difference in measured size between fresh and fixed states. After final processing and mounting, a decrease in size from initial fresh measurement was noted in 40% of cases (mean difference, 2.4 mm; maximum difference, 7 mm). In 9 cases (18%), the measured size increased by a maximum of 3 mm (mean, 1.7 mm) after processing/mounting. Twenty-one cases (42%) showed no change in measurement during the entire fixation and processing protocol. Increases in measured size were attributed largely to tissue expansion during histological sectioning/mounting. One can arguably measure the size of an invasive breast cancer from either the fresh or fixed state without affecting accuracy, but caution should be exercised in relying solely on the microscopic measurements.