Inferring individual attributes from search engine queries and auxiliary information

Internet data has surfaced as a primary source for investigation of different aspects of human behavior. A crucial step in such studies is finding a suitable cohort (i.e., a set of users) that shares a common trait of interest to researchers. However, direct identification of users sharing this trait is often impossible, as the data available to researchers is usually anonymized to preserve user privacy. To facilitate research on specific topics of interest, especially in medicine, we introduce an algorithm for identifying a trait of interest in anonymous users. We illustrate how a small set of labeled examples, together with statistical information about the entire population, can be aggregated to obtain labels on unseen examples. We validate our approach using labeled data from the political domain. We provide two applications of the proposed algorithm to the medical domain. In the first, we demonstrate how to identify users whose search patterns indicate they might be suffering from certain types of cancer. In the second, we detail an algorithm to predict the distribution of diseases given their incidence in a subset of the population at study, making it possible to predict disease spread from partial epidemiological data

Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: Inherited mutations in deoxyribonucleic acid (DNA) mismatch repair (MMR) genes lead to an increased risk of colorectal cancer (CRC), gynaecological cancers and other cancers, known as Lynch syndrome (LS). Risk-reducing interventions can be offered to individuals with known LS-causing mutations. The mutations can be identified by comprehensive testing of the MMR genes, but this would be prohibitively expensive in the general population. Tumour-based tests - microsatellite instability (MSI) and MMR immunohistochemistry (IHC) - are used in CRC patients to identify individuals at high risk of LS for genetic testing. MLH1 (MutL homologue 1) promoter methylation and BRAF V600E testing can be conducted on tumour material to rule out certain sporadic cancers. OBJECTIVES: To investigate whether testing for LS in CRC patients using MSI or IHC (with or without MLH1 promoter methylation testing and BRAF V600E testing) is clinically effective (in terms of identifying Lynch syndrome and improving outcomes for patients) and represents a cost-effective use of NHS resources. REVIEW METHODS: Systematic reviews were conducted of the published literature on diagnostic test accuracy studies of MSI and/or IHC testing for LS, end-to-end studies of screening for LS in CRC patients and economic evaluations of screening for LS in CRC patients. A model-based economic evaluation was conducted to extrapolate long-term outcomes from the results of the diagnostic test accuracy review. The model was extended from a model previously developed by the authors. RESULTS: Ten studies were identified that evaluated the diagnostic test accuracy of MSI and/or IHC testing for identifying LS in CRC patients. For MSI testing, sensitivity ranged from 66.7% to 100.0% and specificity ranged from 61.1% to 92.5%. For IHC, sensitivity ranged from 80.8% to 100.0% and specificity ranged from 80.5% to 91.9%. When tumours showing low levels of MSI were treated as a positive result, the sensitivity of MSI testing increased but specificity fell. No end-to-end studies of screening for LS in CRC patients were identified. Nine economic evaluations of screening for LS in CRC were identified. None of the included studies fully matched the decision problem and hence a new economic evaluation was required. The base-case results in the economic evaluation suggest that screening for LS in CRC patients using IHC, BRAF V600E and MLH1 promoter methylation testing would be cost-effective at a threshold of £20,000 per quality-adjusted life-year (QALY). The incremental cost-effectiveness ratio for this strategy was £11,008 per QALY compared with no screening. Screening without tumour tests is not predicted to be cost-effective. LIMITATIONS: Most of the diagnostic test accuracy studies identified were rated as having a risk of bias or were conducted in unrepresentative samples. There was no direct evidence that screening improves long-term outcomes. No probabilistic sensitivity analysis was conducted. CONCLUSIONS: Systematic review evidence suggests that MSI- and IHC-based testing can be used to identify LS in CRC patients, although there was heterogeneity in the methods used in the studies identified and the results of the studies. There was no high-quality empirical evidence that screening improves long-term outcomes and so an evidence linkage approach using modelling was necessary. Key determinants of whether or not screening is cost-effective are the accuracy of tumour-based tests, CRC risk without surveillance, the number of relatives identified for cascade testing, colonoscopic surveillance effectiveness and the acceptance of genetic testing. Future work should investigate screening for more causes of hereditary CRC and screening for LS in endometrial cancer patients. STUDY REGISTRATION: This study is registered as PROSPERO CRD42016033879. FUNDING: The National Institute for Health Research Health Technology Assessment programme.Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Researc

Screening for breast cancer : medicalization, visualization and the embodied experience

Women’s perspectives on breast screening (mammography and breast awareness) were explored in interviews with midlife women sampled for diversity of background and health experience. Attending mammography screening was considered a social obligation despite women’s fears and experiences of discomfort. Women gave considerable legitimacy to mammography visualizations of the breast, and the expert interpretation of these. In comparison, women lacked confidence in breast awareness practices, directly comparing their sensory capabilities with those of the mammogram, although mammography screening did not substitute breast awareness in a straightforward way. The authors argue that reliance on visualizing technology may create a fragmented sense of the body, separating the at risk breast from embodied experience

Radiation therapy at the end of life in patients with incurable nonsmall cell lung cancer

BACKGROUND: Receipt of chemotherapy at the end of life (EOL) is considered an indicator of poor quality of care for medical oncology. The objective of this study was to characterize the use of radiotherapy (RT) in patients with nonsmall cell lung cancer (NSCLC) during the same period. METHODS: Treatment characteristics of patients with incurable NSCLC who received RT at the EOL, defined as within 14 days of death, were analyzed from the National Comprehensive Cancer Network NSCLC Outcomes Database. RESULTS: Among 1098 patients who died, 10% had received EOL RT. Patients who did and did not receive EOL RT were similar in terms of sex, race, comorbid disease, and Eastern Cooperative Oncology Group performance status. On multivariable logistic regression analysis, independent predictors of receiving EOL RT included stage IV disease (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.09‐3.83) or multiorgan involvement (OR, 1.75; 95% CI, 1.08‐2.84) at diagnosis, age <65 years at diagnosis (OR, 1.85; 95% CI, 1.21‐2.83), and treating institution (OR, 1.24‐5.94; P = .02). Nearly 50% of EOL RT recipients did not complete it, most commonly because of death or patient preference. CONCLUSIONS: In general, EOL RT was received infrequently, was delivered more commonly to younger patients with more advanced disease, and often was not completed as planned. There also was considerable variation in its use among National Comprehensive Cancer Network institutions. Next steps include expanding this research to other cancers and settings and investigating the clinical benefit of such treatment. Cancer 2012. © 2012 American Cancer Society. The authors characterize the use of radiotherapy in patients with incurable nonsmall cell lung cancer during their last 14 days of life and observe that its use is infrequent, it is delivered more commonly to younger patients with more advanced disease, and it is completed as planned only approximately half of the time. There is also significant institutional variation in its use; thus, future investigations should aim to expand this research to other cancers and settings and to investigate the clinical benefit of such treatment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93552/1/27401_ftp.pd

United States cancer statistics: 2002 incidence and mortality

U.S. Cancer Statistics Working Group.Editors: Almon, Lyn ... et al."A joint publication of the Centers for Disease Control and Prevention (CDC) ..., and the National Cancer Institute (NCI) ..., in collaboration with the North American Association of Central Cancer Registries (NAACCR)"--P. v.Also available via the World Wide Web.U.S. Cancer Statistics Working Group. United States Cancer Statistics:2002 Incidence and Mortality. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2005

United States cancer statistics: 1999 incidence

U.S. Cancer Statistics Working Group.Editors: Paul Gargiullo .... [et al.]"A joint publication of the Centers for Disease Control and Prevention (CDC) ..., and the National Cancer Institute (NCI) ..., in collaboration with the North American Association of Central Cancer Registries (NAACCR)"--P. v.Also available via the World Wide Web.CDC Landmar

United States cancer statistics: 2001 incidence and mortality

U.S. Cancer Statistics Working Group.Editors: Almon, Lyn ... et al."A joint publication of the Centers for Disease Control and Prevention (CDC) ..., and the National Cancer Institute (NCI) ..., in collaboration with the North American Association of Central Cancer Registries (NAACCR)"--P. v.Also available via the World Wide Web.U.S. Cancer Statistics Working Group. United States Cancer Statistics:2001 Incidence and Mortality. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2004

Lung cancer diagnosed following emergency admission: a mixed methods study protocol to improve understanding of patients’ characteristics, needs, experiences and outcomes

Background Lung cancer is the leading cause of death from cancer in England. About 40% of patients with lung cancer are diagnosed following an emergency admission (DFEA) to hospital. DFEA is more common in women, and more likely with increasing age and deprivation. Most have advanced disease and survival is poor, but little else is known about this group. The aim of this study is to obtain a detailed understanding of the characteristics, needs, experiences and outcomes of this group. Methods/Design This is a single centre study with quantitative and qualitative work packages (WP). WP1 gathers basic details about all patients diagnosed with lung cancer during a 12 month period, focusing on demographics, diagnostic and treatment pathways and selected outcomes. WP2 obtains information from those patients DFEA or, when unable, their carers, about their holistic needs and experiences, using the Sheffield Profile for Assessment and Referral to Care questionnaire and selected questions from the National Cancer Patient Experience Survey. WP3 uses in-depth qualitative interviews with patients and carers to obtain detailed accounts of their symptoms, help-seeking behaviours prior to admission and subsequent experiences of care. Discussion Relatively little is known about the experiences of lung cancer patients DFEA and this study will provide detailed information about their needs, characteristics, experiences and outcomes. It should identify areas in the diagnostic and treatment pathway where there is scope to improve the care provided to this group of patients and their carers. The findings will also inform the need for further focused research

United States cancer statistics: 2004 incidence and mortality

U.S. Cancer Statistics Working Group.Editors: Umed A. Ajani ... et al."United States Cancer Statistics: 2004 Incidence and Mortality is a joint publication of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and the National Cancer Institute (NCI) in Bethesda, Maryland, in collaboration with the North American Association of Central Cancer Registries, Inc. (NAACCR) in Springfield, Illinois. This is the sixth annual joint report produced by the two federal programs that support population-based cancer registries in the United States: CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results (SEER) Program. This report contains official federal government cancer statistics for more than 1 million invasive cancer cases diagnosed during 2004 among residents of 49 states, 6 metropolitan areas, and the District of Columbia, and these geographic areas are inhabited by about 98% of the U.S. population. In addition to cancer incidence data, we present cancer mortality data collected and processed by CDC's National Center for Health Statistics (NCHS). Mortality statistics, based on records of deaths that occurred during 2004, are available for all 50 states and the District of Columbia." - p. v.Also available via the World Wide Web as an Acrobat .pdf file (8.5 MB, 516 p.).U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2004 Incidence and Mortality. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 200

Omission of surgery in older women with early breast cancer has an adverse impact on breast cancer specific survival

Background: Primary endocrine therapy (PET) is used as an alternative to surgery in up to 40% of UK women with early breast cancer over age 70. This study has investigated the impact of surgery versus PET on breast cancer specific survival (BCSS) in older women. Methods: Cancer registration data were obtained from two English regions from 2002 to 2010 (n=23,961). A retrospective analysis was performed for women with ER positive disease, using statistical modelling to show the effect of treatment (surgery or PET) and age/health status on BCSS. Missing data was handled using multiple imputation. Results: After data pre-processing, 18,730 (78.5%) were identified as having ER positive disease; of these, 10,087 (54%) had surgery and 8,643 (46%) had PET. BCSS was worse in the PET group compared with the surgical group (5 year BCSS: 69% v 90% respectively). This was true for all strata considered, though the differential was lessened in the cohort with the greatest degree of comorbidity. For older, frailer patients the hazard of breast cancer death has less relative impact on overall survival. Selection for surgery on the basis of predicted life expectancy may permit selection of women for whom surgery confers little benefit. This model is being used to develop an on-line algorithm to aid management of older women with early breast cancer (Age Gap Risk Prediction Tool). Conclusion: BCSS in older women with ER positive disease is worse if surgery is omitted. This treatment choice may, therefore, contribute to inferior cancer outcomes