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Mansouri D.,Royal Infirmary | McMillan D.C.,Royal Infirmary | Crearie C.,Royal Infirmary | Morrison D.S.,West of Scotland Cancer Surveillance Unit | And 2 more authors.
British Journal of Cancer | Year: 2015

Background: Population colorectal cancer screening programmes have been introduced to reduce cancer-specific mortality through the detection of early-stage disease. The present study aimed to examine the impact of screening introduction in the West of Scotland.Methods: Data on all patients with a diagnosis of colorectal cancer between January 2003 and December 2012 were extracted from a prospectively maintained regional audit database. Changes in mode, site and stage of presentation before, during and after screening introduction were examined.Results: In a population of 2.4 million, over a 10-year period, 14 487 incident cases of colorectal cancer were noted. Of these, 7827 (54%) were males and 7727 (53%) were socioeconomically deprived. In the postscreening era, 18% were diagnosed via the screening programme. There was a reduction in both emergency presentation (20% prescreening vs 13% postscreening, P≤0.001) and the proportion of rectal cancers (34% prescreening vs 31% pos-screening, P≤0.001) over the timeframe. Within non-metastatic disease, an increase in the proportion of stage I tumours at diagnosis was noted (17% prescreening vs 28% postscreening, P≤0.001).Conclusions: Within non-metastatic disease, a shift towards earlier stage at diagnosis has accompanied the introduction of a national screening programme. Such a change should lead to improved outcomes in patients with colorectal cancer. © 2015 Cancer Research UK. All rights reserved. Source


Shafique K.,University of Glasgow | Shafique K.,Dow University of Health Sciences | Morrison D.S.,University of Glasgow | Morrison D.S.,West of Scotland Cancer Surveillance Unit
PLoS ONE | Year: 2013

In the United Kingdom, survival of prostate cancer patients has improved since the 1990s. A deprivation gap in survival (better survival for the least deprived compared with the most deprived) has been reported but it is not known if differential distribution of earlier age or lower grade disease at diagnosis might explain such patterns. We therefore investigated the impact of age and Gleason grade at diagnosis on the deprivation gap in survival of prostate cancer patients over time. Incident cases of prostate cancer (ICD-10 C61) from the West of Scotland were extracted from the Scottish Cancer Registry from 1991 to 2007. Socio-economic circumstances were measured using the Scottish Index for Multiple Deprivation 2004 (SIMD). Age and deprivation specific mortality rates were obtained from the General Registrar Office for Scotland (GRO(S)). The survival gradient across the five deprivation categories was estimated with linear regression, weighted by the variance of the relative survival estimate. We examined the data for 15,292 adults diagnosed with prostate cancer between 1991 and 2007. Despite substantial improvements in survival of prostate cancer patients, a deprivation gap persists throughout the three periods of diagnoses. The deprivation gap in five year relative survival widened from -4.76 in 1991-1996 to -10.08 in 2003-2007. On age and grade-specific analyses, a significant deprivation gap in five year survival existed between all age groups except among patients' age ≥75 and both low and high grade disease. On multivariate analyses, deprivation was significantly associated with increased excess risk of death (RER 1.48, 95% CI 1.31-1.68, p-value<0.001) independent of age, Gleason grade and period of diagnosis. The deprivation gap in survival from prostate cancer cannot be wholly explained by socio-economic differentials in early detection of disease. Further research is needed to understand whether differences in comorbidities or treatment explain inequalities in prostate cancer outcomes. © 2013 Shafique, Morrison. Source


Morrison D.S.,West of Scotland Cancer Surveillance Unit | Boyle S.,Glasgow and Clyde Weight Management Service | Morrison C.,Greater Glasgow and Clyde NHS Board | Allardice G.,Greater Glasgow and Clyde NHS Board | And 2 more authors.
Public Health Nutrition | Year: 2012

Objective To evaluate the first phase of a specialist weight management programme provided entirely within the UK National Health Service. Design Prospective cohort study using multiple logistic regression analysis to report odds of ≥5 kg weight loss in all referrals and completers, and odds of completion, with 95 % confidence intervals. Anxiety and depression 'caseness' were measured by the Hospital Anxiety and Depression Scale. Setting Glasgow and Clyde Weight Management Service (GCWMS) is a specialist multidisciplinary service, with clinical psychology support, for patients with BMI ≥35 kg/m 2 or BMI ≥30 kg/m 2 with co-morbidities. Subjects All patients referred to GCWMS between 2004 and 2006. Results Of 2976 patients referred to GCWMS, 2156 (72.4 %) opted into the service and 809 completed phase 1. Among 809 completers, 35.5 % (n 287) lost ≥5 kg. Age ≥40 years, male sex (OR = 1.39, 95 % CI 1.05, 1.82), BMI ≥ 50 kg/m 2 (OR = 1.70, 95 % CI 1.14, 2.54) and depression (OR = 1.81, 95 % CI 1.35, 2.44) increased the likelihood of losing ≥5 kg. Diabetes mellitus (OR = 0.55, 95 % CI 0.38, 0.81) and socio-economic deprivation were associated with poorer outcomes. Success in patients aged ≥40 years and with BMI ≥50 kg/m 2 was associated with higher completion rates of the programme. Patients from the most deprived areas were less likely to lose ≥5 kg because of non-completion of the programme. Conclusions Further improvements in overall effectiveness might be achieved through targeting improvements in appropriateness of referrals, retention and effective interventions at specific populations of patients. © The Authors 2011. Source


Shafique K.,University of Glasgow | McLoone P.,West of Scotland Cancer Surveillance Unit | Qureshi K.,Gartnavel General Hospital | Leung H.,Beatson Institute for Cancer Research | And 2 more authors.
Nutrition and Cancer | Year: 2012

Tea may be a potentially modifiable and highly prevalent risk factor for the most common cancer in men, prostate cancer. However, associations between black tea consumption and prostate cancer in epidemiological studies have been inconsistent, limited to a small number of studies with small numbers of cases and short follow-up periods and without grade-specific information. We conducted a prospective cohort study of 6,016 men who were enrolled in the Collaborative Cohort Study between 1970 and 1973 and followed up to December 31, 2007. We used Cox proportional hazards models to investigate the association between tea consumption and overall as well as grade-specific risk of prostate cancer incidence. Three hundred and eighteen men developed prostate cancer in up to 37years of follow-up. We found a positive association between consumption of tea and overall risk of prostate cancer incidence (P = 0.02). The association was greatest among men who drank ≥7 cups of tea per day (HR: 1.50, 95% CI: 1.06 to 2.12), compared with the baseline of 0-3 cups/day. However, we did not find any significant association between tea intake and low-(Gleason <7) or high-grade (Gleason 8-10) prostate cancer incidence. Men with higher intake of tea are at greater risk of developing prostate cancer, but there is no association with more aggressive disease. Further research is needed to determine the underlying biological mechanisms for the association. © 2012 Taylor and Francis Group, LLC. Source


Grose D.,Beatson Oncology Center | Grose D.,West of Scotland Cancer Surveillance Unit | Devereux G.,Royal Infirmary | Brown L.,Royal Infirmary | And 10 more authors.
Journal of Thoracic Oncology | Year: 2011

Background: Treatment and survival rates within Scotland for patients with lung cancer seem lower than in many other European countries. No study of lung cancer has attempted to specifically investigate the association between variation in investigation, comorbidity, and treatment and outcome between different centers. Methods: Patient demographics, World Health Organization/Eastern Cooperative Oncology Group performance status, and primary treatment modality were recorded. In addition to recording the comorbidities present in each patient, the severity of each comorbidity was graded on a 4-point scale (0-3) using validated severity scales. Data were collected as the patient was investigated and entered in an anonymized format into a database designed for the study. Results: Prospectively collected data from 882 patients diagnosed with lung cancer in four Scottish centers. A number of statistically significant differences were identified between centers. These included investigation, treatment between centers (i.e., surgical rates), age, tumor histology, smoking history, socioeconomic profile, ventilatory function, and performance status. Predictors of declining performance status included increasing severity of a number of comorbidities, age, lower socioeconomic status, and specific centers. Conclusions: This study has identified many significant intercenter differences within Scotland. We believe this to be the first study to identify nontumor factors independent of performance status that together limit the ability to deliver radical, possibly curative, therapy to our lung cancer population. It is only by identifying such factors that we can hope to improve on the relatively poor outlook for the majority of Scottish patients with lung cancer. Copyright © 2011 The International Association for the Study of Lung Cancer. Source

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