The proportion of cancer attributable to alcohol consumption

Existing evidence leaves little room for doubt that alcoholic beverages are carcinogenic. Alcohol is a risk factor for cancer of the oral cavity, larynx, esophagus, and possibly the liver. The extent to which carcinogenicity is attributable to the alcohol per se, or to other components of some or all of the beverages that contain it, is unclear. The alcohol effect, at least for cancers of the upper aerodigestive tract, depends on tobacco consumption. About 3% of all U.S. cancers in 1974 are attributable to alcohol; the small proportion and the dependence on tobacco mitigate against antidrinking campaigns for the primary prevention of cancer. It is likely that antismoking campaigns would be more effective than antidrinking campaigns in preventing alcohol-related cancers.     

Estimates of the proportion of bladder cancers attributable to occupation

In order to estimate the proportion of bladder cancers attributable to occupation in different countries, three criteria were defined, each with a different degree of strictness, for the inclusion of job titles or industrial activities in the estimates. Such criteria were applied to the available case-referent studies, the range for the less severe criterion estimates being 0-19% and that of the strictest being 1-19%. The variability was greater among the studies than among the criteria of inclusion of occupations; therefore the study design and time- and place-specificity of exposures play an important role in the magnitude of such estimates.     

Reproducibility of skin characteristic measurements and reported sun exposure history

BACKGROUND: The aim of the present study is to investigate the reproducibility of information on sun exposure, skin characteristics and sunburn collected through a standardized questionnaire used in the multi-centre South European case-control study on skin cancer, 'Helios'. We also intended to use results from reproducibility analysis for correcting odds ratio (OR) estimates from the original study. METHODS: We re-interviewed, with the same questionnaire, a sample of 115 cases of basal cell and squamous cell carcinoma of the skin and 119 population controls, 18-26 months apart, in four centres of Italy, Spain and France. The questionnaire included questions on skin characteristics, sunburns and sun exposure histories. We investigated agreement, studying the association between the difference of the two measures and a set of explanatory variables. According to the results of the reproducibility analysis we corrected OR estimates from the original study simultaneously adjusting for random measurement error. RESULTS: Hair and eye colour showed high agreement with intra-class correlation coefficients (ICC) of 0.81 and 0.74, respectively. Lifetime sun exposure showed substantial agreement with ICC ranging from 0.68 for time spent doing outdoor work to 0.79 for time spent outdoors during holidays and holidays at the beach. The poorest agreement was found for number of lifetime sunburns (ICC = 0.25), while sunburns during childhood showed a substantial agreement (Cohen's Kappa = 0.67). Lack of reproducibility was mainly associated with subjects' education, while no significant differences were observed between cases and controls. The corrected OR showed a moderate increase with a reinforcement of the effect of sun exposure and skin reaction to sun exposure. CONCLUSION: Overall, there was good reproducibility, particularly in the case of sun exposure histories, between answers given on two different occasions to a questionnaire administered by trained interviewers. However, since measurement error can substantially bias OR toward the null value, it should be taken into account in estimates of the effect of sun exposure on risk of skin cancer.     

Proportion of lung tumors attributable to occupation

This paper reviews estimates of the proportion of lung cancer attributable to occupational exposures and presents estimates for the City of Turin where a population-based case-control study on lung cancer has been conducted in 1991-1992 among the residents. An analysis of six hundred and five cases (505 males and 100 females) and 859 controls (684 males and 175 females) with histological/cytological confirmed diagnosis of lung cancer and occupational and smoking complete histories has been performed to estimate the proportion of lung cancers attributable to occupation in the city of Turin. The occupational exposure has been assessed with two different classifications: a) classification of a checklist of occupations as obtained from the study questionnaire according to industries and occupations known (List A) and suspected (List B) to be associated with lung cancer; b) translation of ISCO-ISIC codes for industries and occupations according to the same List A and List B. The population attributable risks are comparable when estimated with the two different classifications. In the city of Turin, at the beginning of the Nineties, about 10%-15% of lung cancers in males and 2%-5% in females could be attributed to occupational exposure.     

Estimate of the mortality rate attributable to occupational diseases in Spain, 2004

BACKGROUND: Occupational diseases are not registered in Spain to a sufficient degree so as to be able to evaluate the impact thereof in our country. In this study, the occupational disease-related mortality and the costs thereof are estimated based on attributable risks calculated in international literature. METHODS: Attributable risk estimates are applied for the occupationally-caused deaths rate calculated by Nurminen and Karjalainen (Finland, 2001) are applied to the total number of deaths by the relevant diseases and age groups in Spain and in Autonomous Communities in 2004. The potential years of life and working life lost are calculated. Based upon the years of working life lost, the updated costs of the loss of productive life due to deaths caused by occupational diseases in Spain are estimated. RESULTS: According to our estimates, nearly 16,000 deaths would have occurred in Spain due to occupational exposure-related diseases, the majority in males (87%). These deaths could have caused nearly 152,000 potential years of life lost and somewhat over 47,000 potential years of working life lost, which would entail an updated cost in productivity losses of 580 million - 1 billion euros. CONCLUSIONS: In 2004, the occupational disease register in Spain included solely two deaths due to this cause. The results of this study however reveal the importance of working conditions as determining factors in preventable deaths among the population and the imminent need for adequate surveillance and prevention systems for dealing with this public health problem in its full magnitude.     

Radon exposure of the skin: II. Estimation of the attributable risk for skin cancer incidence.

A preceding companion paper has reviewed the various factors which form the chain of assumptions that are necessary to support a suggested link between radon exposure and skin cancer in man. Overall, the balance of evidence was considered to be against a causal link between radon exposure and skin cancer. One factor against causality is evidence, particularly from animal studies, that some exposure of the hair follicles and/or the deeper dermis, as well as the inter-follicular epidermis, is required-beyond the range of naturally occurring alpha particles. On this basis any skin cancer risk due to radon progeny would be due only to beta and gamma components of equivalent dose, which are 10-100 times less than the alpha equivalent dose to the basal layer. Notwithstanding this conclusion against causality, calculations have been carried out of attributable risk (ATR, the proportion of cases occurring in the total population which can be explained by radon exposure) on the conservative basis that the target cells are, as is often assumed, in the basal layer of the epidermis. An excess relative risk figure is used which is based on variance weighting of the data sources. This is 2.5 times lower than the value generally used. A latent period of 20 years and an RBE of 10 are considered more justifiable than the often used values of 10 years and 20 respectively. These assumptions lead to an ATR of approximately 0.7% (0.5-5%) at the nominal UK indoor radon level of 20 Bq m(-3). The range reflects uncertainties in plate-out. Previous higher estimates by various authors have made more pessimistic assumptions. There are some indications that radon progeny plate-out may be elevated out of doors, particularly due to rainfall. Although average UK outdoor radon levels ( approximately 4 Bq m(-3)) are much less than average indoor levels, and outdoor residence time is on average about 10%, this might have the effect of increasing the ATR several-fold. This needs considerable further study. Ecological epidemiology data for the South West of England provide no evidence for elevated skin cancer risks at radon levels <100 Bq m(-3). Case-control or cohort studies would be necessary to address the issue authoritatively.     

The extrapolation of attributable risk to new populations

I develop a method for extrapolation of attributable risk estimated from one population, to other populations with a different rate of risk factor exposure and/or rate of outcome. The method uses the relationship between attributable risk and the product moment correlation.     

Nitrate and nitrite exposure in Italian populations with different gastric cancer rates

Exposure to nitrate and nitrite from dietary sources was estimated by questionnaire and measurement of salivary levels of the ions in residents of four regions of Italy with longstanding, contrasting, gastric cancer mortality rates. Whether using salivary levels or dietary questionnaire estimations no association was found between nitrate and nitrite exposure and gastric cancer mortality rates. For salivary nitrate and nitrite, the intra-provincial variation was greater than any inter-province difference. However, for dietary nitrate and nitrite intakes, there were significant differences between the regional groups (but not related to gastric cancer risk). Despite the limitations of the methods used, there was a weak positive association between salivary concentrations of nitrate and questionnaire assessment. Dietary factors are likely to play key roles at different stages of the gastric carcinogenic process. Nitrate may play a part but is unlikely to be a rate-limiting factor in all individuals or populations.     

Estimating the incidence of lung cancer attributable to occupational exposure in Iran

Objective  

The aim of this study was to estimate the fraction of lung cancer incidence in Iran attributed to occupational exposures to the well-established lung cancer carcinogens, including silica, cadmium, nickel, arsenic, chromium, diesel fumes, beryllium, and asbestos.     

Race differences in the proportion of low birth weight attributable to maternal cigarette smoking in a low-income population

PURPOSE: To quantify race differences in the public health impact of maternal cigarette smoking on infant birth weight and to estimate the proportion of low birth weight births that could be prevented by maternal smoking cessation. DESIGN: A cohort that consisted of 77,751 mother-infant pairs was evaluated retrospectively. SETTING: Statewide study of Women, Infants and Children participants in North Carolina. SUBJECTS: African-American and non-Hispanic white women who delivered a single live infant during 1988, 1989, or 1990. MEASURES: Logistic regression estimates of the relative risk of low birth weight births for smokers were used to calculate adjusted population attributable risk percentages for smoking. Separate population attributable risk percentages were calculated for total low birth weight, moderately low birth weight, and very low birth weight, and all estimates were adjusted for prepregnancy body mass index, gestational weight gain, age, education, parity, and timing of entry into prenatal care. RESULTS: Non-Hispanic whites had a much higher prevalence of smoking and were heavier smokers than African-Americans. For both moderately low birth weight and very low birth weight, the population attributable risk percentages for smoking were twice as high for non-Hispanic whites than for African-Americans. Overall, after adjustment, 30.7% of low birth weight births among non-Hispanic whites and 14.4% of low birth weight births among African-Americans were attributable to smoking. CONCLUSIONS: Although the public health impact of maternal cigarette smoking on infant birth weight was twice as high for non-Hispanic whites as for African-Americans in this low-income population, smoking cessation by all low-income pregnant women would result in significant improvements in infant health and well-being.     

Squamous cell and basal cell carcinoma of the skin in relation to radiation therapy and potential modification of risk by sun exposure

BACKGROUND: Epidemiologic studies consistently find enhanced risk of basal cell carcinoma of the skin among individuals exposed to ionizing radiation, but it is unclear whether the radiation effect occurs for squamous cell carcinoma. It is also not known whether subgroups of individuals are at greater risk, eg, those with radiation sensitivity or high ultraviolet radiation exposure. METHODS: We analyzed data from a case-control study of keratinocyte cancers in New Hampshire. Incident cases diagnosed in 1993-1995 and 1997-2000 were identified through a state-wide skin cancer surveillance system, and controls were identified through the Department of Transportation and Center for Medicare and Medicaid Service Files (n = 1121 basal cell carcinoma cases, 854 squamous cell carcinoma cases, and 1049 controls). RESULTS: We found an association between history of radiation treatment and basal cell carcinoma. The association was especially strong for basal cell carcinomas arising within the radiation treatment field (odds ratio = 2.6; 95% confidence interval = 1.5-4.3), and among those treated with radiation therapy before age 20 (3.4; 1.8-6.4), those whose basal cell carcinomas occurred 40 or more years after radiation treatment (3.2; 1.8-5.8), and those treated with radiation for acne (11; 2.7-49). Similar age and time patterns of risk were observed for squamous cell carcinoma, although generally with smaller odds ratios. For basal cell carcinoma, early exposure to radiation treatment was a risk factor largely among those without a history of severe sunburns, whereas for squamous cell carcinoma, radiation treatment was a risk factor primarily among those with a sun-sensitive skin type (ie, a tendency to sunburn). CONCLUSIONS: Radiation treatment, particularly if experienced before age 20, seems to increase the long-term risk of both basal and squamous cell carcinomas of the skin. These risks may differ by sun exposure or host response to sunlight exposure.     

Occupational exposure to noise and the attributable burden of hearing difficulties in Great Britain

Aims: To determine the prevalence of self reported hearing difficulties and tinnitus in working aged people from the general population, and to estimate the risks from occupational exposure to noise and the number of attributable cases nationally.

Methods: A questionnaire was mailed to 22 194 adults of working age selected at random from the age–sex registers of 34 British general practices (21 201 subjects) and from the central pay records of the British armed services (993 subjects). Information was collected on years of employment in a noisy job; and whether the respondent wore a hearing aid, had difficulty in hearing conversation, or had experienced persistent tinnitus over the past year. Associations of hearing difficulty and tinnitus with noise exposure were examined by logistic regression, with adjustment for age, sex, smoking habits, and frequent complaints of headaches, tiredness, or stress. The findings were expressed as prevalence ratios (PRs) with associated 95% confidence intervals (CIs). Attributable numbers were calculated from the relevant PRs and an estimate of the prevalence of occupational exposure to noise nationally.

Results: Some 2% of subjects reported severe hearing difficulties (wearing a hearing aid or having great difficulty in both ears in hearing conversation in a quiet room). In men, the prevalence of this outcome rose steeply with age, from below 1% in those aged 16–24 years to 8% in those aged 55–64. The pattern was similar in women, but severe hearing loss was only about half as prevalent in the oldest age band. Tinnitus was far more common in subjects with hearing difficulties. In both sexes, after adjustment for age, the risk of severe hearing difficulty and persistent tinnitus rose with years spent in a noisy job. In men older than 35 years with 10 or more years of exposure, the PR for severe hearing difficulty was 3.8 (95% CI 2.4 to 6.2) and that for persistent tinnitus 2.6 (95% CI 2.0 to 3.4) in comparison with those who had never had a noisy job. Nationally, some 153 000 men and 26 000 women aged 35–64 years were estimated to have severe hearing difficulties attributable to noise at work. For persistent tinnitus the corresponding numbers were 266 000 and 84 000.

Conclusions: Significant hearing difficulties and tinnitus are quite common in men from the older working age range. Both are strongly associated with years spent in a noisy occupation—a predominantly male exposure. The national burden of hearing difficulties attributable to noise at work is substantial.

     

Towards estimating the burden of disease attributable to second-hand smoke exposure in Polish children

Objectives

To estimate the burden of disease attributable to second-hand smoke (SHS) exposure in Polish children in terms of the number of deaths and disability adjusted life years (DALYs) due to lower respiratory infections (LRI), otitis media (OM), asthma, low birth weight (LBW) and sudden infant death syndrome (SIDS).

Materials and Methods

Estimates of SHS exposure in children and in pregnant women as well as information concerning maternal smoking were derived from a national survey, the Global Youth Tobacco Survey, and the Global Adult Tobacco Survey in Poland. Mortality data (LRI, OM, asthma, and SIDS), the number of cases (LBW), and population data were obtained from national statistics (year 2010), and DALYs came from the WHO (year 2004). The burden of disease due to SHS was calculated by multiplying the total burden of a specific health outcome (deaths or DALYs) by a population attributable fraction.

Results

Using two estimates of SHS exposure in children: 48% and 60%, at least 12 and 14 deaths from LRI in children aged up to 2 years were attributed to SHS, for the two exposure scenarios, respectively. The highest burden of DALYs was for asthma in children aged up to 15 years: 2412, and 2970 DALYs, for the two exposure scenarios, respectively. For LRI, 419 and 500 DALYs, and for OM, 61 and 77 DALYs were attributed to SHS, for the two exposure scenarios, respectively. Between 13% and 27% of SIDS cases and between 3% and 16% of the cases of LBW at term were attributed to SHS exposure.

Conclusions

This study provides a conservative estimate of the public health impact of SHS exposure on Polish children. Lack of comprehensive, up to date health data concerning children, as well as lack of measures that would best reflect actual SHS exposure are major limitations of the study, likely to underestimate the burden of disease.     

沈阳农村居民手背部皮肤纹理与日光暴露关系

目的了解中国北方地区农村居民皮肤纹理与日光暴露的关系。方法采用整群抽样方法抽取长期居住在辽宁省沈阳市王滨乡的当地居民361人作为调查对象,对收集到的手背部皮肤图像评定老化级别,使用Image-Pro Plus 5.0图像分析软件测量皮肤纹理间距、纹理形成的角度和网格数。结果沈阳农村居民日光高暴露和低暴露组皮肤老化级别平均值分别为(4.48±1.14)和(3.65±1.43)分,达到老化的人数分别为154和97人,老化比例分别为83.7%和54.8%;各年龄组日光高暴露组皮肤老化水平和老化比例均高于低暴露组,但差异均无统计学意义(P>0.05);年龄10～19和30～49岁及老化级别为4～6级时,日光高暴露组农村居民手部皮肤纹理的最大角度均大于低暴露组(P<0.05)。结论沈阳市农村居民皮肤纹理形成的角度与日光暴露密切相关。     

Measures of cumulative exposure from a standardized sun exposure history questionnaire: a comparison with histologic assessment of solar skin damage

Ultraviolet radiation exposure is the dominant environmental determinant of all major forms of skin cancer; however, the nature of the association is incompletely understood. Existing instruments to capture sun exposure history tend to yield reproducible results, but the validity of these responses is unknown. To address this question, the authors examined the relation between responses to a standardized sun exposure instrument and histologic evidence of actinic damage in a population-based study of keratinocyte cancers from New Hampshire diagnosed from July 1, 1997, through March 31, 2000. A single study dermatopathologist histologically reviewed the adjacent skin of 925 skin cancer biopsies for the presence of solar keratoses and the extent of solar elastosis. The authors compared these measures with responses to a personal interview on history of sunburns, sunbathing, and time spent outdoors. Focusing on site-specific exposure, they found variables that estimated cumulative exposure related to histologic evidence of actinic damage. In contrast, measures of acute/intermittent exposure were generally unrelated to solar damage histologically. Findings suggest that cumulative, but not intermittent, measures of sun exposure derived from a personal interview appear to reflect a person's exposure history based on histologic evidence.     

Behavior of caregivers to protect their infants from exposure to the sun in Queensland,Australia

Exposure to the sun by infants has been demonstrated to increase the risk of the development of melanoma and other skin cancers later in life. A cohort of 508 women who delivered healthy Caucasian babies were followed up at 1 year to determine their knowledge, attitudes and practices regarding sun protection towards themselves and their child. In addition, the 1-year-old infants were assessed by a trained nurse for the number of nevi they had on their skin. Results indicate caregivers reported a high level of sun-protection practices towards their child, with 93% of the caregivers reporting usually or always placing the child in the shade when going outside. Further, 81% of the caregivers reported usually or always placing a hat on the child, while 64% reported usually or always applying sunscreen to the child's exposed skin. Interestingly, only 61% of the caregivers reported that they stayed in the shade to reduce sun exposure and only 42% wore a hat when out in the sun. Mother's own personal sun-protection methods predicted the method of sun protection that she would most likely use for the child. While children appear to be reasonably protected from the sun, they are influenced by their mother's own behaviors.     

Risk and incidence of asthma attributable to occupational exposure among HMO members

Occupational asthma may account for a significant proportion of adult-onset asthma, but incidence estimates from surveillance of physician reports and workers' compensation data (0.9 to 15/100,000) are lower than expected from community-based cross-sectional studies of asthma patients. We conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55 at risk for asthma. Computerized files, medical records, and telephone interviews were used to identify and characterize asthma cases. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure. The annual incidence of clinically significant, new-onset asthma was 1.3/1,000, and increased to 3.7/1,000 when cases with reactivation of previously quiescent asthma were included. Criteria for onset of clinically significant asthma attributable to occupational exposure were met by 21% (95% CI 12–32%) of cases giving an incidence of 71/100,000 (95% CI 43–111). Physicians documented asking about work-related symptoms in 15% of charts, and recorded suggestive symptoms in three cases, but did not obtain occupational medicine consultation, diagnose occupational asthma, report to the state surveillance program, or bill workers' compensation for any of them. These data suggest that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported, and accounts for a sizable proportion of adult-onset asthma. Am. J. Ind. Med. 33:1–10, 1998. © 1998 Wiley-Liss, Inc.