Sep 22

Stomach (Gastric) Cancer Screening (PDQ®) - Evidence of Benefit

Gastroscopic examination has been proposed as a screening method for the early detection of gastric cancer. No randomized trials evaluating the impact of screening on mortality from gastric cancer have been reported, although a Japanese study randomizing municipalities within a prefecture is ongoing.[1]

Time-trend analysis and case-control studies of gastric endoscopy suggest a twofold decrease in gastric cancer mortality in screened versus unscreened individuals;[2,3,4,5,6] however, this stands in contrast to studies of stronger design.

A cohort study of 24,134 individuals with a follow-up period of 40 months did not demonstrate a statistically significant decrease in gastric cancer mortality among men or women who were screened compared with those who were not screened.[7] A larger prospective study examined the association between screening in the past 12 months and subsequent gastric cancer mortality and other-cause mortality. The risk of death from gastric cancer and from causes of death other than gastric cancer were reduced among those who had participated in gastric cancer screening programs, demonstrating a selection for healthier individuals into screening programs.[8]

Another cohort study was conducted in Linqu County, China, where gastric cancer rates are high, in which over 4,000 adult residents were screened. Individuals were screened at an average of 4.5 year intervals, except for a high-risk subset (689 individuals) that was screened 2 years after the initial examination. Of the 85 cases of gastric cancer occurring in the cohort, 58 were detected with screening. No impact on gastric cancer mortality was observed among screened individuals. The standardized mortality ratio (SMR) for gastric cancer 10 years after the initial screen was 1.01 (95% confidence interval, 0.72–1.37). The SMR for all-cause mortality was significantly lower among participants since individuals with hypertension, liver disease, and chronic obstructive pulmonary disease were not eligible to participate.[9] The study was not designed to evaluate screening, and the intervals between screens were long.

A screening study was begun in Venezuela in 1980, using radiographic fluorography.[10] The efficacy of this program in reducing mortality from stomach cancer was evaluated by means of a case-control study. Analyses determined that the tests were ineffective in reducing mortality from gastric cancer.

In Japan, measurement of serum pepsinogen (PGI and PGII) levels in 5,113 subjects also screened by endoscopy (13 gastric cancers detected), used cut-off points for identifying risk for gastric cancer of less than 70 ng/mL for pepsinogen I and less than 3 for the PGI:PGII ratio. This combination provided a sensitivity of 84.6%, a specificity of 73.5%, a positive predictive value of 0.81%, and a negative predictive value of 99.6%.[11]

There may be some justification for screening some populations of Americans at higher risk, although there is considerable discussion about how much incidence would make the examination worthwhile. Potential subgroups might include elderly with atrophic gastritis or pernicious anemia, patients with partial gastrectomy,[12] patients with the diagnosis of sporadic adenomas,[13] familial adenomatous polyposis,[14] or hereditary nonpolyposis colon cancer,[15] and immigrant ethnic populations from countries with high rates of gastric carcinoma.[16,17]

References:

  1. Hisamuchi S, Fukao P, Sugawara N, et al.: Evaluation of mass screening programme for stomach cancer in Japan. In: Miller AB, Chamberlain J, Day NE, et al., eds.: Cancer Screening. Cambridge: Cambridge University Press, 1991, pp 357-372.
  2. Murakami R, Tsukuma H, Ubukata T, et al.: Estimation of validity of mass screening program for gastric cancer in Osaka, Japan. Cancer 65 (5): 1255-60, 1990.
  3. Kampschöer GH, Fujii A, Masuda Y: Gastric cancer detected by mass survey. Comparison between mass survey and outpatient detection. Scand J Gastroenterol 24 (7): 813-7, 1989.
  4. Oshima A, Hirata N, Ubukata T, et al.: Evaluation of a mass screening program for stomach cancer with a case-control study design. Int J Cancer 38 (6): 829-33, 1986.
  5. Hirayama T, Hisamichi S, Fujimoto I, et al.: Screening for gastric cancer. In: Miller AB, ed.: Screening for Cancer. New York, NY: Academic Press, 1985, pp 367-376.
  6. Tytgat GN, Mathus-Vliegen EM, Offerhaus J: Value of endoscopy in the surveillance of high-risk groups for gastrointestinal cancer. In: Sherlock P, Morson BC, Barbara L, et al., eds.: Precancerous Lesions of the Gastrointestinal Tract. New York, NY: Raven Press, 1983, pp 305-318.
  7. Inaba S, Hirayama H, Nagata C, et al.: Evaluation of a screening program on reduction of gastric cancer mortality in Japan: preliminary results from a cohort study. Prev Med 29 (2): 102-6, 1999.
  8. Mizoue T, Yoshimura T, Tokui N, et al.: Prospective study of screening for stomach cancer in Japan. Int J Cancer 106 (1): 103-7, 2003.
  9. Riecken B, Pfeiffer R, Ma JL, et al.: No impact of repeated endoscopic screens on gastric cancer mortality in a prospectively followed Chinese population at high risk. Prev Med 34 (1): 22-8, 2002.
  10. Pisani P, Oliver WE, Parkin DM, et al.: Case-control study of gastric cancer screening in Venezuela. Br J Cancer 69 (6): 1102-5, 1994.
  11. Kitahara F, Kobayashi K, Sato T, et al.: Accuracy of screening for gastric cancer using serum pepsinogen concentrations. Gut 44 (5): 693-7, 1999.
  12. Staël von Holstein C, Eriksson S, Huldt B, et al.: Endoscopic screening during 17 years for gastric stump carcinoma. A prospective clinical trial. Scand J Gastroenterol 26 (10): 1020-6, 1991.
  13. Ming S, Goldman H: Gastric polyps: a histogenetic classification and its relation to carcinoma. Cancer 18(6): 721-726, 1965.
  14. Utsunomiya J, Maki T, Iwama T, et al.: Gastric lesion of familial polyposis coli. Cancer 34 (3): 745-54, 1974.
  15. Aarnio M, Salovaara R, Aaltonen LA, et al.: Features of gastric cancer in hereditary non-polyposis colorectal cancer syndrome. Int J Cancer 74 (5): 551-5, 1997.
  16. Kurtz RC, Sherlock P: The diagnosis of gastric cancer. Semin Oncol 12 (1): 11-8, 1985.
  17. Boeing H: Epidemiological research in stomach cancer: progress over the last ten years. J Cancer Res Clin Oncol 117 (2): 133-43, 1991.
Sep 15
Obituary: RNL
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Robert Noe Lichtenberger

 

 

Robert Noe Lichtenberger April 7, 1943 - April 30, 2008 Robert N. Lichtenberger, 65, of Austin passed away in his home after a courageous battle with cancer. Born in Corpus Christi, Texas to Beulah and Noe Lichtenberger. Robert “Bob” grew up in South Texas and graduated high school in Agua Dulce. He was Salutatorian in his class and a letterman in multiple sports. Turning down a 4 year college scholarship, Bob left South Texas to serve his country and enlisted in the United States Army in 1962. Bob enjoyed a successful military career and was highly decorated for his command abilities and performance in combat. During one of his tours in the Vietnam War as a Cobra gunship pilot, Bob was wounded and awarded the Purple Heart Medal. This medal would play a significant role later in Bob’s life. Other foreign tours included the Middle East and Panama, taking his family with him on both assignments. While on active duty, Bob earned his Bachelor of Arts, Summa Cum Laude, from Benedictine College in Atchison, KS and his Master of Arts from the University of Kansas in Lawrence, KS. Other notable military accomplishments include command of an artillery battalion, foreign area officer for Latin American countries, graduating and instructing at the US Inter-American Defense College, and induction into the OCS Hall of Fame. Bob retired with 28 years of service and the rank of Colonel in 1990. Bob’s post-military career was spent working in the financial industry and serving veterans as a member and officer of the Military Order of the Purple Heart. Bob served as the National Commander of this organization in 2004, advocating veterans’ issues at the local, state and national levels. Bob also spent a significant amount of time working with the Hispanic community by providing financial advice to families as well as coaching and mentoring Hispanic loan officers. A beloved husband and father, Bob is preceded in death by his parents and an infant brother. He is survived by his wife, Sharron Sue Radney Lichtenberger; five children: son, Robert N. Lichtenberger, Jr., his wife Wendi and their two daughters Kaitlin and Ava of Shawnee, KS; son, John P. Lichtenberger, his wife Lynna and their three children Jared, Paige, and Reid of Austin, TX; daughter, Lori A. Thomas, her husband Steve and their two sons Hudson and Weston of Coppell, TX; son G. Sean Lichtenberger, his wife Lauren and their three children, Ethan, Kaylie, and Kaya of Savannah, GA; stepson, Todd E. R. Bowden, his wife Laurie and their daughter Taylor Kate of Phoenix, AZ; an uncle, Nick Lichtenberger of Freer, TX; numerous cousins; and countless friends. A visitation will be held at 6:00 p.m. on Monday, May 5, 2008 at Weed-Corley-Fish Chapel followed by a Rosary beginning at 7:00 p.m. Funeral services will be held at 2:00 p.m. on Tuesday, May 6, 2008 at St. Catherine of Siena Catholic Church, 4800 Convict Hill, Austin. Interment will follow at Texas State Cemetery. In lieu of flowers, we ask that donations be made to the Colonel Robert N. “Bob” Lichtenberger Cancer Awareness Foundation, checks can be sent to Montemayor, Hill & Company, P.C., c/o Archie Montemayor, III, CEO, 3001 South Lamar Blvd., Suite 320, Austin, Texas 78704. Obituary and guestbook online at http://wcfish.com

Published in the Austin American-Statesman on 5/4/2008

 
Sep 15

…And Later That Evening, The…

NATIONAL COMMANDER’S DINNER

 

…Downtown In The Austin Club, at 6PM, Saturday, April 9th…

 

There was so much of the MOPH leadership, past and present, that came from everywhere in the country to

honor Chapter 1919’s own, Bob Lichtenberger, National Commander, that it could be described as the “night

the Purple Heart stars fell on Austin.” Thirteen of the first fifteen names on Purple Heart Magazine’s page 2

list of national officers were there. All six Region Commanders; and no less than five past National

Commanders were in attendance. The night was really all about Bob; but, helping make it all into a

memorable occasion, the Navy and the Air Force ROTC detachments of the University of Texas provided

Color Guards, National PR Director Ray Funderburk was master of ceremonies, Paul Dvorak assisted by

Wendy Moore presented the world premier of a special entertainment piece titled, “Purple Heart Soldier,”

written by Ray Funderburk, Unit 1919 Musician, Barbara Carr, provided inspirational and patriotic themed

piano music during the social hour and dinner and led the assembly in singing of the National Anthem and

God Bless America, and National Chaplain, Father Leonard Stegman, rendered the invocation and the

benediction in closing, after which everyone seemed to go away happy.

Sep 15

Robert Lichtenberger

MOPHEAGLE is soaring above us all today, as he lays in his final resting place at The Texas State Cemetery, in Austin Texas. From deep in the heart of Texas, many Purple Heart veterans came to honor the retired Army Colonel who had served as mentor, brother, and devoted husband and father. 

Sue Lichtenberger, Bob’s wife, gave a very courageous address on Monday evening at the Chapel where family and friends came to celebrate the life of Robert Lichtenberger. 

In her heart rendering talk, Sue related stories about how much the, “Purple Heart” extended family meant to him. Personally, Bob was one of the Past National Commander’s that was always there to help with advice, and could set the record straight. I will miss his sharp ability to cut to the chase and get to the focal point of an issue. 

At graveside, Col. Lichtenberger received a true Military burial, including full color guard from the 1st Cavalry, Scottish Rite Bagpiper, Mounted Cavalry Horse, Twenty One Gun Salute, Taps, and a fly-over from a Blackhawk helicopter from Ft. Sam Houston. The final resting place of our Past National Commander sits under a Live Oak Tree within full view of Stephen F. Austin’s Monument and grave. Bob Lichtenberger will be remembered as a loyal Patriot, who always saw his missions completed. Today, and for all time, the Eyes of Texas are upon him.