Objective. To estimate the prevalence, incidence, survival, and disease characteristics of systemic sclerosis (SSc) in the Detroit tricounty area.Methods. A census of SSc cases for the period 1989-1991 was conducted in the Detroit area, using multiple sources for case identification. Diagnoses were verified by medical record review. Capture-recapture analysis was used to estimate the total SSc population. Cases of localized scleroderma (morphea and linear disease) were excluded.Results. Based on 706 verified cases of SSc, prevalence was initially estimated to be 242.0 cases per million adults (95% confidence interval [95% CI] 213-274), with an annual incidence of 19.3 new cases per million adults per year (95% CI 12.4-30.2). Capturerecapture analysis, based on the degree of overlap of verified cases among multiple sources, resulted in a revised prevalence estimate of 276 cases per million adults (95% CI 245-310). Sex-and race-specific prevalence estimates were significantly higher for women than for men, and for blacks than for whites. The average age at diagnosis was significantly younger for blacks than for whites. Compared with white patients, black patients were almost twice as likely to have diffuse disease (prevalence proportion ratio 1.86, 95% CI 1.48-2.35). Median survival was ϳ11 years. Factors negatively affecting survival included male sex (hazard ratio 1.81, 95% CI 1.29-2.55) and older age at diagnosis (hazard ratio 1.04, 95% CI 1.03-1.05).Conclusion. This study establishes baseline estimates of SSc occurrence and characteristics in a large US cohort consisting primarily of black adults and white adults. These data should facilitate research regarding the role of geographic, ethnic, racial, and environmental factors for this disease in comparison populations.

BACKGROUND The modulation of immunologic activities relevant to cancer by behavioral factors, such as stress, depression, and social support, is well documented. However, associations of behavioral factors with cytokines involved in tumor angiogenesis have not been studied. Vascular endothelial growth factor (VEGF) is a key cytokine that is capable of stimulating tumor angiogenesis, and it has been associated with poorer survival in patients with ovarian carcinoma. VEGF is modulated by a variety of behaviorally sensitive factors, including sympathetic activation. This study examined relationships of social support and depressive symptoms with VEGF levels in preoperative patients with ovarian carcinoma. METHODS Twenty‐four women with ovarian carcinoma and 5 women with benign pelvic masses were recruited at the presurgical clinic visit, received psychosocial surveys, including the Functional Assessment of Cancer Therapy (Quality of Life) survey and the Profile of Mood States, and a blood draw. Serum VEGF levels were assessed by enzyme‐linked immunosorbent assay. Analyses controlled for disease stage. RESULTS Women with ovarian carcinoma who reported higher levels of social well being had lower levels of VEGF (P = 0.005). Greater support from friends and neighbors (P = 0.005) and less distance from friends (P = 0.04) were facets of social well being that were associated with lower VEGF levels. Individuals who reported greater helplessness (P = 0.03) or worthlessness (P = 0.08) had higher VEGF levels, but depression as a whole (P > 0.50) was not related to VEGF levels. CONCLUSIONS Higher levels of social well being were correlated with lower VEGF levels in presurgical patients with ovarian carcinoma. These findings suggest a possible mechanism by which poor social support may be associated with disease progression. Further study of these relations may demonstrate novel pathways relating biobehavioral factors to tumor growth and disease progression. Cancer 2002;95:808–15. © 2002 American Cancer Society. DOI 10.1002/cncr.10739

Preoperative CA 125 is an independent risk factor for death due to disease in ovarian cancer, but not a reliable predictor of optimal cytoreduction.

Objective. To examine racial differences in disease onset, extent, manifestations, and survival among women with scleroderma.Methods. A retrospective cohort study of women with scleroderma, diagnosed in Michigan between 1980 and 1991, was conducted. Clinical, laboratory, and demographic data were abstracted from the patients' medical records.Results. A total of 514 women with scleroderma were identified: 117 (23%) were black and 397 (77%) were white. Among black women, the mean age at diagnosis was lower (44.5 years versus 51.5 years; P < 0.001) and diffuse disease was more common (49.6% versus 24.9%; P < 0.001) than among white women. The overall incidence of scleroderma was 14.1 per million per year: 22.5 per million per year in black women versus 12.8 per million per year in white women (P < 0.001). Pericarditis (P = 0.009), pulmonary hypertension (P < 0.001), pleural effusions (P = 0.01), myositis (P = 0.02), and an erythrocyte sedimentation rate >40 mmlhour (P < 0.001) were more frequent among black women, while white women were more likely to have digital infarctions (P < 0.001). Survival at 7 years from form October 25, 1996. diagnosis was 72.5% among black women and 77.6% among white women. Age-adjusted survival was significantly reduced among black women (P = 0.033), most likely because of increased diffuse involvement. Survival among those with renal or pulmonary involvement was also significantly reduced.Conclusion. Black women with scleroderma were significantly more likely than white women to develop diffuse disease, be diagnosed at a younger age, have a higher incidence of inflammatory features, and have a worse age-adjusted survival rate.Scleroderma is an uncommon connective tissue disease that is characterized by variable degrees of fibrosis within the skin and internal organs. Previous epidemiologic studies have provided estimates of incidence, prevalence, and mortality, and have identified the various clinical and laboratory manifestations that distinguish the diffuse and limited scleroderma subtypes (1,2). In addition, some investigators have suggested important differences between black and white women with regard to incidence, mortality, case fatality, and extent of disease manifestations (3-5). However, few studies have contained sufficient numbers of both black and white women to completely identify and confirm these observations.As part of a population-based case-control study to identify potential risk factors among women with scleroderma, we recruited a large, racially diverse cohort of women with scleroderma in Michigan (6). During review of their medical records, 74 clinical and laboratory parameters were recorded, as well as demographic information, date of diagnosis, and date of death or last followup examination. These data enabled us to examine racial differences in age at diagnosis, extent of disease, clinical manifestations, incidence of disease, and survival.

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