Agricultural Injury in California Hispanic Farm Workers: MICASA Follow-up Survey

ABSTRACT

The authors report here results from the first follow-up survey of the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) cohort of community-dwelling immigrant Hispanic farm workers in California's Central Valley. Among 560 participants the authors observed cumulative 1-year injury incidence of 6.6% (all injuries) and 4.3% (agricultural injuries). Increased prospective injury risk was associated with males, US birth, years lived in the United States, family income, and poor self-rated health. Agricultural injuries were associated most frequently with being struck by an object, falls, and cutting instruments, whereas over two thirds of nonagricultural injuries involved motor vehicles. Prevention should focus on safe handling of tools and materials, falls, and motor vehicle safety.     

Occupational Histories of Cancer Patients in a Canadian Cancer Treatment Center and the Generated Hypothesis Regarding Breast Cancer and Farming

Abstract

Occupational exposures increase cancer risks. The Windsor Regional Cancer Centre in Windsor, Ontario, was the first Canadian cancer treatment center to collect the work histories of its patients, which were recorded using a computer-based questionnaire. Breast cancer cases represented the largest respondent group. The lifetime occupational histories of 299 women with newly diagnosed breast cancers were compared with those of 237 women with other cancers. Odds ratios (ORs) were calculated using logistic regression, adjusting for age, social class, and education. The OR for women ≤ 55 years of age with breast cancer who had ever farmed, compared with women of the same age with other cancers, was 9.05 (95% CI 1.06, 77.43). Patients' occupational histories can help to inform understanding of cancer etiology and prevention. This effort points to a need for investigation of the possible association between breast cancer and agricultural hazards such as pesticides.     

Postmenopausal Estrogen Use and Invasive versus in situ Breast Cancer Risk

To examine the effect of cancer histopathology on the relationship between estrogen-replacement therapy (ERT) use and breast cancer risk, we performed a case-control study of 109 postmenopausal women 45 years or older with in situ or invasive breast cancer matched to 545 controls. When in situ and invasive tumors were combined, the overall odds ratio (OR) describing the association between ERT use and breast cancer risk was not statistically significantly elevated (adjusted OR = 1.48, 95% confidence interval [CI] = 0.89–2.47). When the analyses were confined to women with invasive disease, risk estimates were uniformly higher (adjusted OR = 1.85, 95% CI = 1.00–3.45). In contrast, the overall estimate for the relationship between ERT use and in situ breast cancer was close to 1 (adjusted OR = 1.08, 95% CI = 0.42–2.77). The positive association between ERT use and invasive breast cancer we observed, and the lack of association in women with in situ disease, may represent a distinct biological difference or may be related to the small sample size of our study.     

Knowledge, Attitudes, and Perceptions about Breast Cancer and Breast Cancer Screening Among Hispanic Women Residing in South Central Pennsylvania

The purpose of this investigation was to assess the knowledge, attitudes, and perceptions about breast cancer, and screening behaviors among Hispanic women in Pennsylvania. Eight focus groups were conducted with Hispanic women to obtain answers to the questions of interest. Results, based on content analysis, showed that cultural factors, such as family and fatalism, influence breast cancer knowledge and screening among this group. In addition, these women had some misconceptions regarding breast cancer and breast cancer detection screening. Most participants reported that they would like to receive breast cancer education in Spanish from health care providers or health educators. These results can help health professionals, including health educators, in the development of suitable breast cancer education and screening promotion programs for Hispanic women. This study was funded by the Research Council of The Penn State Capital College.     

Hospice Use by Hispanic and Non-Hispanic White Cancer Decedents

Objective. To investigate rates of hospice use between Hispanic and non-Hispanic white Medicare beneficiaries diagnosed with cancer using data from a large, population-based study.
Data Sources. Secondary data from the linked SEER-Medicare database including the SEER areas of Los Angeles, San Francisco, and San Jose–Monterey, California, and the state of New Mexico. All subjects were Hispanic or non-Hispanic whites, aged 67 and older, had a cancer diagnosis of breast, colorectal, lung, or prostate cancer from 1991–1996, and died of cancer from 1991–1998.
Study Design. This study employed a retrospective cohort design to compare rates of hospice use between Hispanics and non-Hispanic whites across patient characteristics and over time.
Principal Findings. Rates of hospice use were similar for Hispanics (39.2 percent) and non-Hispanic whites (41.5 percent). In a bivariate logistic regression model, Hispanics were significantly less likely to use hospice than non-Hispanic whites (OR 0.91; 95 percent CI 0.85–0.97). However, after adjusting for age, marital status, sex, educational attainment, income, urban versus rural residence, and type of insurance using multivariate logistic regression analysis, the estimated odds for being a hospice user among Hispanics is similar to the odds of being a hospice user among non-Hispanic whites (OR 1.05; 95 percent CI 0.98–1.13). Stratified analyses revealed significant differences between ethnic groups in the use of hospice by type of insurance and SEER area, indicating interactions between ethnicity and these variables.
Conclusions. Our findings indicate similar rates of hospice use for Hispanics and non-Hispanic whites diagnosed with one of the four leading cancers. Additional studies from other national registries may be necessary to confirm these findings.     

滕州市乳腺癌危险因素的病例对照研究

目的调查滕州市女性乳腺癌危险因素,为确定高危人群、制定干预对策与措施提供依据。方法选取滕州市2007年1月-2009年5月期间,经病理学证实的102例乳腺癌患者,进行1:1的病例对照研究,用SPSS12.0软件进行单因素和多因素logistic分析。结果经多因素非条件Logistic回归分析,最终进入模型的因素为乳腺良性疾病史、不良性格、流产史、月经初潮年龄及哺乳史,其OR值分别为3.411、2.479、1.751、0.725和0.282。结论乳腺良性疾病史、不良性格、流产史、月经初潮年龄小的人群易患乳腺癌,母乳喂养是乳腺癌发病的保护性因素。     

Risk of Developing Breast Cancer by Utilizing Gail Model

The Gail model has been widely used to quantify an individual woman's risk of developing breast cancer by using important clinical parameters, usually for clinical counselling purposes or to determine eligibility for mammography and genetic tests. The aim of the present study was to estimate the five-year and lifetime breast cancer risk among women in Rasht, Iran. In this cross-sectional study, 314 women were evaluated at Alzahra Women Hospital in 2007. Participants were ≥35 years of age without a history of breast cancer. Risk estimation was performed using the computerized Gail model. A five-year risk >1.66% was considered high-risk; 5.1% of women were high-risk. The mean five-year breast cancer risk was 0.8% (SD±1). Mean breast cancer risk up to the age of 90 years (lifetime risk) was 9.0% (SD±3.9%); 16.2% of the participants had a five-year risk higher than the average woman of the same age, and 18.2% had the same risk. Also for the lifetime risk, 11.1% of the women had higher risk and 1.6% had the same risk as the average woman. Routine use of the Gail model is recommended for identifying women at high average risk for increasing the survival of women from breast cancer.     

BMI与中国女性三阴型乳腺癌发病风险的分析

目的 探讨不同绝经状态下,体重指数(BMI)与中国女性三阴型乳腺癌发病风险的关系及对应的敏感界值。方法 采用匹配病例对照研究设计,病例和对照按年龄和绝经状态1∶2匹配,于2010年至2014年序贯收集四川省肿瘤医院391名原发性三阴型乳腺癌新发病例,同期收集成都市妇女儿童中心医院社区来源的健康对照782名。采用结构式问卷调查收集研究对象的一般人口学特征、身高、体重、生殖生育因素、现患及既往疾病史等信息。在不同绝经状态下,采用不同BMI分类标准（WHO四分类、亚洲四分类、中国四分类）估计BMI水平与三阴型乳腺癌的关联度,统计方法采用Logistic回归分析。结果 调整了年龄、初潮年龄、初产年龄、初潮和初产年龄的时间间隔等信息后,WHO二分类划分标准提示,高BMI与绝经前、后TNBC发病呈正相关（aOR绝经前= 2.19,95%CI:1.40～3.43;aOR绝经后=2.05,95%CI:1.29～3.27）。绝经前TNBC,WHO四分类中超重（BMI:25.0～29.9 kg/m2）和肥胖（BMI≥30.0 kg/m2）的aOR分别为:1.97（95%CI:1.23～3.15）和5.45（95%CI:1.07～27.74）;绝经后TNBC,中国四分类中肥胖（BMI≥28.0 kg/m2）的aOR为2.14（95%CI:1.02～4.48）。连续性BMI的趋势分析显示,不同绝经状态下随着BMI增高乳腺癌发病风险增大（Pfor trend ＜0.05）。结论 对于中国女性,高BMI是三阴型乳腺癌发病的危险因素,且绝经前后应采用不同的BMI敏感界值（BMI绝经前 ≥25.0 kg/m2,BMI绝经后≥28kg/m2）来估计三阴型乳腺癌的发病风险。     

Racial and Ethnic Disparities in the Impact of Obesity on Breast Cancer Risk and Survival: A Global Perspective

Obesity is a global concern, affecting both developed and developing countries. Although there are large variations in obesity and breast cancer rates worldwide and across racial/ethnic groups, most studies evaluating the impact of obesity on breast cancer risk and survival have been conducted in non-Hispanic white women in the United States or Europe. Given the known racial/ethnic differences in tumor hormone receptor subtype distribution, obesity prevalence, and risk factor profiles, we reviewed published data for women of African, Hispanic, and Asian ancestry in the United States and their countries of origin. Although the data are limited, current evidence suggests a stronger adverse effect of obesity on breast cancer risk and survival in women of Asian ancestry. For African Americans and Hispanics, the strength of the associations appears to be more comparable to that of non-Hispanic whites, particularly when accounting for subtype and menopausal status. Central obesity seems to have a stronger impact in African-American women than general adiposity as measured by body mass index. International data from countries undergoing economic transition offer a unique opportunity to evaluate the impact of rapid weight gain on breast cancer. Such studies should take into account genetic ancestry, which may help elucidate differences in associations between ethnically admixed populations. Overall, additional large studies that use a variety of adiposity measures are needed, because the current evidence is based on few studies, most with limited statistical power. Future investigations of obesity biomarkers will be useful to understand possible racial/ethnic biological differences underlying the complex association between obesity and breast cancer development and progression.     

Breastfeeding and Risk of Breast Cancer: Case-Control Study

The aim of this study was to investigate a possible association of breast cancer occurrence in women with their breastfeeding experience. A matched case-control study was conducted in Kragujevac, Serbia. A total of 382 women (191 cases with breast cancer and 191 controls) were interviewed, but the data were explored on breastfeeding and breast cancer only among parous women (339 women). Logistic regression was used to calculate odds ratios (ORs) as estimates of the relative risk of breast cancer. Compared with controls, significantly more cases ever breastfed [adjusted OR (OR_adj) = 2.90, 95 percent confidence interval (95 percent CI) 1.02–8.22], breastfed all their children (OR_adj = 2.93; 95 percent CI 1.03–8.29), and had longer lifetime duration of breastfeeding (OR_adj = 3.44, 95 percent CI 1.15–10.24 for 13 or more months). In comparison with controls, significantly more cases breastfed at first birth (OR_adj = 3.17, 95 percent CI 1.36–7.37). Breast cancer risk increased if first breastfeeding occurred at an older age (p for trend = .042) and with longer duration of breastfeeding (p for trend = .037). Our study is one of the few in which breastfeeding was found to be a risk factor for breast cancer.     

Risk factors for systemic illnesses following agricultural exposures to restricted organophosphates in California, 1984–1988

Organophosphate (OP)-related systemic illnesses reported to the Worker Health and Safety (WH&S) Branch, and restricted OP-related agricultural use data reported to the Information Services Branch at the California Department of Food and Agriculture (CDFA) (now CAL-EPA) during 1984–1988 were used to assess factors associated with OP-related systemic illnesses. Counts of OP-related systemic illnesses (numerator), relative to OP-related use data (denominator), such as pounds applied, number of applications, and acres treated (pounds applied/acres treated), were analyzed by crop treated, season of application, method of application, geographic region, and by specific OP applied. A Relative Illness/Use Ratio (RIUR) was calculated by Poisson regression. The highest risk of systemic illness was associated with OP applications to fleshy fruit (mainly fruit trees) compared to all other crops combined (RIUR = 2.9, 95%CI = 2.2–3.9) using pounds applied in the denominator, followed by vegetables and melons (RIUR = 1.9, 95%CI = 1.4–2.4). Air applications resulted in higher RIURs for systemic illness than did ground applications (RIUR = 2.1, 95%CI = 1.7–2.5). Specific OPs that showed significantly elevated RIURs for systemic illness when compared to other OPs were Mevinphos (RIUR = 5.8, 95%CI = 5.0–6.8). Demeton (RIUR = 4.3, 95%CI = 2.6–7.1). Oxydemeton-Methyl (RIUR = 3.8 95%CI = 3.0–4.9). Methamidophos (RIUR = 1.6, 95%CI = 1.2–2.0) and Azinphos-Methyl (RIUR = 1.3, 95%CI = 1.1–1.6). Am. J. Ind. Med. 31:572–579, 1997. © 1997 Wiley-Liss, Inc.     

Differences in Risk Factors for Breast Cancer: Lesbian and Heterosexual Women

Purpose/Objectives: To compare differences in risk for developing breast cancer between lesbian and heterosexual women. Design: Retrospective medical record review. Setting: Lyon-Martin Women's Health Services (LMWHS) in San Francisco, California. Sample: Women age 35 or older, seen at LMWHS in 1995, 1996, or 1997, who described themselves as either lesbian or heterosexual. The typical participant (n = 1019) was 42.9 years old (SD = 6.85, range 35–75), white (70%), and employed (49.9%). Most were without health insurance and 99% were poor (<$15,780 annual income). Of this sample, 57.6% (n = 586) described themselves as heterosexual and 42.4% (n = 433) as lesbian. Measurements: Medical Record Audit Form completed by two research assistants with an interrater reliability of more than 95%. Results: There were no significant differences between the lesbian and heterosexual women in family history of breast cancer, current or past alcohol use and history of blackouts or alcohol problems, age at menarche and menopause, use of hormone replacement therapy, ever having had a mammogram or age at most recent mammogram, nor the prevalence of breast cancer. The lesbians reported more breast biopsies and had a higher body mass index; the heterosexuals had higher rates of current smoking, pregnancy, children, miscarriages, abortions, and use of birth control pills. Conclusions: There were significant differences between lesbian and heterosexual women in some of the risk factors for the development of breast cancer. Future studies should sample women of different ages, economic groups, and geographic regions. In particular, the finding that lesbians report more breast biopsies should be further explored.     

Does a High Folate Intake Increase the Risk of Breast Cancer?

Although not uniformly consistent, epidemiologic studies generally suggest an inverse association between dietary intake and blood measurements of folate and breast cancer risk. However, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening trial has recently reported for the first time a potential harmful effect of high folate intake on breast cancer risk. In this study, the risk of developing breast cancer was significantly increased by 20% in women reporting supplemental folic acid intake ≥ 400 μg/d compared with those reporting no supplemental intake. Furthermore, although food folate intake was not significantly related to breast cancer risk, total folate intake, mainly from folic acid supplementation, significantly increased breast cancer risk by 32%. The data from the PLCO trial support prior observations made in epidemiologic, clinical, and animal studies suggesting that folate possesses dual modulatory effects on the development and progression of cancer depending on the timing and dose of folate intervention. Based on the lack of compelling supportive evidence, routine folic acid supplementation should not be recommended as a chemopreventive measure against breast cancer at present.     

Breast Cancer Internet Information

Abstract

Breast cancer is the most common cancer among women in North America and Europe. Every woman is at risk. The two most important risk factors are being female and getting older. The earlier breast cancer is found, the more likely it can be cured. This article describes Web sites that provide information about prevention, risk factors, diagnosis, treatment, and coping with breast cancer.     

Occupational Risk Factors for Breast Cancer among Nurses

Abstract

A case-referent study nested in a cohort was used to evaluate occupational variables in the incidence of breast cancer among nurses. There were 59 cases and 118 randomly chosen referents. The participation rate was 97%. Odds ratios (ORs) and 95% confidence intervals (Cls) were calculated and the weights of potential confounding factors estimated by unconditional logistic regression. The odds ratio for breast cancer in a sister was 2.83 (95% CI 1.03–7.81). Specialization in pediatric, psychiatric, general (surgical and medical), geriatric, and primary care nursing, and “other kinds of nursing,” gave an adjusted OR of 1.95 (95% CI 0.84–4.54). When working in different wards was accounted for, the highest adjusted ORs were found among nurses handling cytotoxic drugs, OR 1.65 (95% CI 0.53–5.17), and among pediatric nurses, OR 1.47 (95% CI 0.63–3.41); the lowest ORs were found among nurses in primary health care, OR 0.44 (95% CI 0.20–0.96). Analyses of the data stratified on age showed similar results. Occupational risks were not ascertained. Not only occupation but also career-related lifestyles should be taken into account in studies of health outcomes among working women.     

女性乳腺癌与部分行为因素的病例对照研究分析

目的评价女性乳腺癌部分行为危险因素的作用,为乳腺癌的病因学研究和预防提供依据。方法运用Meta分析方法对国内外2001-2010年间公开发表的有关乳腺癌行为危险因素病例对照研究的30篇文献资料进行定性综合分析。结果哺乳、饮酒、流产、主动吸烟、口服避孕药合并OR值分别为0.71（0.60～0.85）、0.78（0.49～1.24）、1.43（0.88～2.31）、1.05（0.98～1.13）及1.11（0.93～1.33）,敏感分析前后差别不大,被动吸烟敏感分析前后合并OR值分别为1.45（1.11～1.90）和1.06（0.85～1.31）,得出结论不一致。结论被动吸烟是女性乳腺癌发生的危险因素,哺乳是保护因素,不能得出饮酒、主动吸烟及口服避孕药与女性乳腺癌发生危险有关联的结论。     

A Prognostic Model Based on Nutritional Risk Index in Operative Breast Cancer

Background: The nutritional risk index (NRI) is an independent prognostic factor for overall survival in various cancers, but its prognostic value in breast cancer remains unclear. This study aimed to explore the relationship between the NRI and overall survival (OS) in breast cancer and to develop a predictive nomogram. Methods: We retrospectively enrolled 1347 breast cancer patients who underwent mastectomy or lumpectomy between January 2011 and November 2012. Using a cutoff value of 110.59, patients were divided into a high-NRI group and a low-NRI group. OS was compared between the two groups. Clinicopathological factors independently associated with survival were used to construct a predictive nomogram. Results: Of the 1347 patients, 534 patients were classified as high NRI and 813 as low NRI. OS was significantly shorter in low-NRI patients. The 3- and 5-year OS rates were 87.3% and 73.4%, respectively, in the high-NRI group whereas they were 83.0% and 67.2%, respectively, in the low-NRI group. Cox regression analysis found that histopathological type, tumor size, lymph node status, progesterone receptor (PR) status, Ki-67, and NRI were independently associated with OS. Conclusions: NRI is an independent prognostic factor of OS in breast cancer patients. The proposed nomogram model may be a useful tool for individualized survival prediction.     

Agricultural exposures and gastric cancer risk in Hispanic farm workers in California

Previous studies have indicated that farm workers may be at increased risk of gastric cancer. Meta-analyses, ecological, case-control, and cohort studies suggest that some aspects of the agricultural environment may be implicated in the elevated risk. Hispanic farm workers in California are exposed to a multitude of potentially toxic substances in the work site, including excessive sunlight, fertilizers, diesel fumes, and pesticides. A previous analysis of a cohort of California farm workers who had been members of a farm labor union, the United Farm Workers of America (UFW) found a proportionate cancer incidence ratio for stomach cancer of 1.69 when using the California Hispanic population as the standard. The aim of the current study was to further evaluate associations between gastric cancer and the types of crops and commodities UFW members cultivate and the associated pesticide use as recorded by the California Department of Pesticide Regulation (DPR). We conducted a nested case-control study of gastric cancer embedded in the UFW cohort and identified 100 cases of newly diagnosed gastric cancer between 1988 and 2003. We identified 210 control participants matched on age, gender, ethnicity, and who were known to be alive and resident in California up to the date of the cases' diagnosis. Both stratified analyses and unconditional logistic regression were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Work in the citrus industry was associated with increased gastric cancer (OR=2.88; 95% CI=1.02-8.12) although no other specific crops or commodities were associated with this disease. Working in areas with high use of the phenoxyacetic acid herbicide 2,4-D was associated with gastric cancer (OR=1.85; 95% CI=1.05-3.25); use of the organochlorine insecticide chlordane was also associated with the disease (OR=2.96; 95% CI=1.48-5.94). Gastric cancer was associated with use of the acaricide propargite and the herbicide triflurin (OR=2.86; 95% CI=1.56-5.23 and 1.69, 95% CI=0.99-2.89, respectively). Gastric cancer in California Hispanic farm workers is associated with work in the citrus fruit industry and among those who work in fields treated with 2,4-D, chlordane, propargite, and trifluin. These findings may have larger public health implications especially in those areas of the country where these pesticides are heavily used and where they may be found in the ambient atmosphere.     

唐山地区女性乳腺癌环境危险因素的病例对照研究

[目的] 探讨唐山地区女性乳腺癌的环境危险因素. [方法]采用1∶1配比的病例对照研究,对经病理确诊的166例女性乳腺癌病人匹配对照后进行条件logistic回归分析.[结果]单因素分析显示:室内杀虫剂使用年限长、有机溶剂暴露年限长、农药暴露年限长、放射线检查次数多、体重指数高、精神刺激、行经年数长、流产次数多为危险因素;而水果、豆制品摄入次数和生育胎次多为保护因素.多因素分析显示:室内杀虫剂使用年限长(OR=1.747,95%CI:1.163～2.624,P=0.007)、有机溶剂暴露年限长(OR=2.221,95%CI:1.005～4.125,P=0.037)、体重指数高(OR=1.661,95%CI:1.110～2.486,P=0.014)、精神刺激(OR=1.923,95%CI:1.352～3.968,P=0.041)为危险因素;水果摄入次数多(OR=0.751,95%CI:0.591～0.954,P=0.019)、豆制品摄入次数多(OR=0.732,95%CI:0.570～0.939,P=0.014)和生育胎次多(OR=0.314,95%CI:0.129～0.766,P=0.011))为保护因素.市区组与县郊区组的环境危险因素存在一定差别.[结论]唐山地区女性乳腺癌危险因素中,室内杀虫剂使用、有机溶剂暴露、饮食因素等环境因素起着重要的作用.     

Workplace Exposures and Protective Practices of Hispanic Warehouse Workers

Background This study was undertaken to assess workplace hazards and protective practices among Hispanic men and women working post-harvest in asparagus, apple and pear packaging warehouses. Methods Three focus groups were conducted in July 2003 with 25 workers (20 women, 5 men) recruited from communities in the Yakima Valley, Washington. Focus group content informed the design of an in-person structured interview administered to 50 additional warehouse workers from August to November 2006. Results Focus group participants reported difficult working conditions, exposure to chemicals, adverse health effects and use of work and home protective practices to minimize exposures for themselves and their families. Structured interview participants reported few workplace exposures to chemicals although many reported engaging in workplace and home protective practices. Discussion Findings from this research can direct initial efforts to determine if and how interventions for warehouse workers may be designed to protect against hazardous workplace exposures.