Objective Risk-reducing salpingo-oophorectomy (RRSO) is recommended for women with BRCA mutation due to increased risk of pelvic serous carcinoma. Serous tubal intraepithelial carcinoma (STIC) is a pathologic finding of unknown clinical significance. This study evaluates the clinical outcome of patients with isolated STIC. Materials/Methods We retrospectively reviewed the medical records of consecutive patients with a germline BRCA1/2 mutation or a high-risk personal or family history of ovarian cancer who underwent RRSO between January 2006 and June 2011. All patients had peritoneal washings collected. All surgical specimens were assessed using the sectioning and extensively examining the fimbria protocol, with immunohistochemistry when indicated. p53 signature lesions and secretory cell outgrowths were excluded. Results Of 593 patients who underwent RRSO, isolated STIC was diagnosed in 12 patients (2%). Five patients (42%)were BRCA1 positive, 5 patients (42%)were BRCA2 positive, and 2 patients (17%) had high-risk family history. Preoperatively, all patients with STIC had normal CA-125 levels and/or pelvic imaging results. Seven patients underwent hysterectomy and omentectomy, 6 patients (46%) had pelvic node dissections, and 5 patients (39%) had para-aortic node dissections. With the exception of positive peritoneal washings in 1 patient, no invasive or metastatic disease was identified. No patient received adjuvant chemotherapy. At median follow-up of 28 months (range, 16–44 months), no recurrences have been identified. Conclusions Among the cases of isolated STIC after RRSO reported in the literature, the yield of surgical staging is low, and short-term clinical outcomes are favorable. Peritoneal washings are the most common site of disease spread. Individualized management is warranted until additional data become available.
ObjectiveSugar-sweetened beverage (SSB) consumption had substantially increased across successive US birth cohorts until 2000, and adolescents and young adults under age 50 years have the highest consumption. However, the link between SSBs and early-onset colorectal cancer (EO-CRC) remains unexamined.DesignIn the Nurses’ Health Study II (1991–2015), we prospectively investigated the association of SSB intake in adulthood and adolescence with EO-CRC risk among 95 464 women who had reported adulthood beverage intake using validated food frequency questionnaires (FFQs) every 4 years. A subset of 41 272 participants reported beverage intake at age 13–18 years using a validated high school-FFQ in 1998. Cox proportional hazards models were used to estimate relative risks (RRs) with 95% CIs.ResultsWe documented 109 EO-CRC cases. Compared with individuals who consumed <1 serving/week of SSBs in adulthood, women who consumed ≥2 servings/day had a more than doubled risk of EO-CRC (RR 2.18; 95% CI 1.10 to 4.35; ptrend=0.02), with a 16% higher risk (RR 1.16; 95% CI 1.00 to 1.36) per serving/day increase. Each serving/day increment of SSB intake at age 13–18 years was associated with a 32% higher risk of EO-CRC (RR 1.32; 95% CI 1.00 to 1.75). Replacing each serving/day of adulthood SSB intake with that of artificially sweetened beverages, coffee, reduced fat milk or total milk was associated with a 17%–36% lower risk of EO-CRC.ConclusionHigher SSB intake in adulthood and adolescence was associated with a higher risk of EO-CRC among women. Reduction of SSB consumption among adolescents and young adults may serve as a potential strategy to alleviate the growing burden of EO-CRC.
Background Prompt detection of colorectal cancer under age 50 (early-onset CRC) is a clinical priority due to its alarming rise. Methods We conducted a matched case-control study of 5075 incident early-onset CRC among U.S. commercial insurance beneficiaries (113 million adults aged 18-64) with ≥2 years of continuous enrollment (2006-2015) to identify red-flag signs/symptoms between 3 months to 2 years before the index date among 17 pre-specified signs/symptoms. We assessed diagnostic intervals according to the presence of these signs/symptoms before and within 3 months of diagnosis. Results Between 3 months to 2 years before the index date, four red-flag signs/symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with ORs ranging from 1.34 to 5.13. Having 1, 2, or ≥ 3 of these signs/symptoms were associated with a 1.94 (95% CI, 1.76 to 2.14), 3.59 (2.89 to 4.44), and 6.52 (3.78 to 11.23)-fold risk (Ptrend < .001), with stronger associations for younger ages (Pinteraction < .001) and rectal cancer (Pheterogenity=0.012). The number of different signs/symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. About 19.3% of cases had their first sign/symptom occur between 3 months to 2 years before diagnosis (median diagnostic interval: 8.7 months), and around 49.3% had the first sign/symptom within 3 months of diagnosis (median diagnostic interval: 0.53 month). Conclusions Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, or iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC.
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