Are Coffee, Tea, and Total Fluid Consumption associated with Bladder Cancer Risk? Results from the Netherlands Cohort Study

Objectives: Coffee, tea, and fluid consumption have been thought to influence bladder cancer incidence. In a large prospective study, these associations were investigated. Methods: In 1986, cohort members (55–69 years) completed a questionnaire on cancer risk factors. Follow-up was established by linkage to cancer registries until 1992. The multivariable case–cohort analysis was based on 569 bladder cancer cases and 3123 subcohort members. Results: The incidence rate ratios (RR) for men consuming <2 cups of coffee/day was 0.89 (95% CI 0.51–1.5) using the median consumption category (4–<5 cups/day) as reference. This RR increased to 1.3 (95% CI 0.94–1.9) for men consuming 7 cups/day, although no clear dose–response association was found. The RRs decreased from 1.2 (95% CI 0.56–2.7) for women consuming <2 cups of coffee/day to 0.36 (95% CI 0.18–0.72) for women consuming 5 cups/day compared to the median consumption category (3–<4 cups/day). Men and women who abstained from drinking tea had a RR of 1.3 (95% CI 0.97–1.8) compared to those consuming 2–<3 cups of tea per day (median consumption category). The RR for men and women comparing highest to lowest quintile of total fluid consumption was 0.87 (95% CI 0.63–1.2). Conclusion: The data suggest a possible positive association between coffee consumption and bladder cancer risk in men and a probable inverse association in women. Tea consumption was inversely associated with bladder cancer. Total fluid consumption did not appear to be associated with bladder cancer.     

Dietary patterns and risk of colon cancer and adenoma in a cohort of men (United States)

BackgroundExamining the effects of dietary patterns on cancer risk may provide insights beyond the assessment of individual foods or nutrients. Design: In the health professionals follow-up cohort, associations between the prudent and the western dietary pattern and risk of colon cancer and adenomas were examined in 561 colon cancer cases and 1207 distal colon adenoma cases. Results: Higher prudent pattern scores were only weakly and non-significantly associated with decreased risk of colon cancer or distal colon adenoma (highest versus lowest quintile: colon cancer: multivariate adjusted relative risk (RR)=0.84 (95 confidence interval (CI)=0.64–1.10); p_trend=0.37; distal adenoma: multivariate odds ratio (OR)=0.88 (95 CI=0.73–1.08); p_trend=0.12). Our findings suggest a moderately increased risk of colon cancer and distal adenoma with higher western pattern scores (colon cancer: RR=1.27 (95 CI=0.96–1.69), p_trend=0.05; distal adenoma: OR=1.28 (95 CI=1.05–1.56), p_trend=0.01). Adding body mass index, which is positively related to western pattern and thus may be considered an intermediate endpoint between western pattern and colon cancer, attenuated associations somewhat but not substantially. Conclusion: Our data do not provide evidence for an appreciable inverse association between higher prudent pattern scores and risk of colon cancer or distal colon adenomas, but do support a moderate positive association between higher western pattern scores and risk of colon cancer or distal colon adenomas.     

Racial differences in the familial aggregation of breast cancer and other female cancers

Summary Although breast cancer familial aggregation has been studied in Caucasians, information for African–Americans is scant. We used family cancer history from the Womens Contraceptive and Reproductive Experiences study to assess the aggregation of breast and gynecological cancers in African–American and Caucasian families. Information was available on 41,825 first and second-degree relatives of Caucasian and 28,956 relatives of African–American participants. We used a cohort approach in which the relatives cancer status was the outcome in unconditional logistic regression and adjusted for correlated data using generalized estimating equations. Race-specific models included a family history indicator, the relatives age, and type. Relative risk (RR) estimates for breast cancer were highest for first-degree relatives, and the overall RR for breast cancer among case relatives was 1.96 (95% CI = 1.68–2.30) for Caucasian and 1.78 (95% CI = 1.41–2.25) for African–Americans. The effect of CARE participants reference age on their relatives breast cancer risk was greatest among first-degree relatives of African–American patients with RRs (95% CI) for ages <45 and 45 of 2.97 (1.86–4.74) and 1.48 (1.14–1.92), respectively. Among Caucasians, first-degree relatives of case subjects were at greater risk for ovarian cancer, particularly relatives younger than 45 years (RR (95% CI) = 2.06 (1.02–4.12)), whereas African–American first-degree relatives of case subjects were at increased cervical cancer risk (RR (95% CI) = 2.17 (1.22–3.85). In conclusion, these racially distinct aggregation patterns may reflect different modes of inheritance and/or environmental factors that impact cancer risk.*The first two authors contributed equally to this work.     

Prospective study of serum retinol, β-carotene, β-cryptoxanthin, and lutein/zeaxanthin and esophageal and gastric cancers in China

Objective: This study examined the relationship between pretrial serum concentrations of retinol, -carotene, -cryptoxanthin, and lutein/zeaxanthin and the subsequent risk of developing esophageal squamous cell carcinoma and gastric cardia or non-cardia adenocarcinoma in subjects selected from a randomized nutritional intervention trial in Linxian, China, a region with epidemic rates of esophageal and gastric cardia cancer. Methods: We used a stratified case–cohort design to select cohort members for inclusion in this study. In all we measured serum concentrations of the above vitamins in 590 esophageal, 395 gastric cardia, and 87 gastric non-cardia case subjects as well as in 1053 control subjects. Relative risks (RRs) were estimated using Cox proportional hazards models. Results: Median values in our cohort were low for serum retinol (33.6 g/dl), -carotene (4.3 g/dl), and -cryptoxanthin (3.5 g/dl) , but were high for lutein/zeaxanthin (40.0 g/dl). Gastric cardia cancer incidence fell 10% for each quartile increase in serum retinol (RR = 0.90, 95% CI = 0.83–0.99). For esophageal cancer, an inverse association with retinol levels was found only in male non-smokers (RR = 0.79 per quartile increase, 95% CI = 0.63–0.99). For gastric non-cardia cancer, an inverse association was limited to subjects 50 years old or younger (RR = 0.58 per quartile, 95% CI = 0.31–0.96). For -cryptoxanthin there was a borderline significant protective association for gastric non-cardia cancer (RR = 0.88 per quartile, 95% CI = 0.76–1.0). In contrast, we found the incidence of gastric non-cardia cancer increased (RR = 1.2 per quartile, 95% CI = 1.0–1.3) with increasing concentration of serum lutein/zeaxanthin. Conclusions: In this population, we found that low retinol and high lutein/zeaxanthin concentrations increased the risks of gastric cardia and gastric non-cardia cancer respectively. We found that there were no strong associations between any of the other analytes and any of the cancer sites.     

Dietary intakes of fruit,vegetables, and fiber,and risk of colorectal cancer in a prospective cohort of women (United States)

Objective: Although animal studies suggest an inverse association between consumption of plant foods and risk of colorectal cancer, many observational data have failed to support such an association. We prospectively examined the association between dietary intakes of fruit, vegetables, and fiber and colorectal cancer risk in a large female cohort from the Womens Health Study.Methods: Among 39,876 healthy women aged 45 years at baseline, 36,976 with baseline self-reported information on dietary intakes and other risk factors for colorectal cancer were included in the analyses. During an average follow-up of 10 years, 223 women were diagnosed with colorectal cancer. Intakes of fruit, vegetables, and fiber were assessed by a baseline food-frequency questionnaire. The analyses were carried out using the Cox proportional hazards regression and all tests were two-sided.Results: Intakes of fruit, vegetables, and the specific subgroups were not found to be associated with colorectal cancer risk. Multivariate relative risks (RRs) comparing the highest with lowest quintile were 0.79 (95% CI = 0.49–1.27,pfor trend = 0.30) for fruit intake, and 0.88 (95% CI=0.56–1.38,pfor trend=0.30) for vegetables intake. Similarly, intake of total fiber was not associated with colorectal cancer risk; the RR for the highest relative to lowest quintile was 0.75 (95% CI=0.48–1.17,pfor trend=0.12). However, higher intake of legume fiber was associated with a lower risk of colorectal cancer; the RR for the highestversuslowest quintile was 0.60 (95% CI=0.40–0.91,pfor trend=0.02).Conclusions: Our data offer little support for associations between intakes of fruit, vegetables, and fiber, and colorectal cancer risk. However, our data suggest that legume fiber and/or other related sources may reduce risk of colorectal cancer.     

Increased risk of second cancers following breast cancer: Role of the initial treatment

Objectives and methods.The risk of second primary malignancies (SMN) was studied in a cohort of 4,416 one-year survivors of a breast cancer. The role of the menopausal status and of the initial treatment modalities (surgery, radiotherapy, and chemotherapy) was investigated. Results.Excluding second primary breast cancer and non-melanoma skin cancer, a total of 193 (4.4%) patients developed a SMN between 1973 and 1992, compared with 136 expected (Standardised Incidence Ratio, SIR=1.4, 95% CI (1.2–1.6)). No trend towards either an increase or a decrease was noted in the SIR with time after treatment (p=0.2). The greatest increase in the relative risk concerned soft tissue cancers (SIR=13.0, 95% CI: 6.8–22.3), followed by leukaemia (SIR=3.1, 95% CI: 1.7–5.0), melanoma (SIR = 2.7, 95% CI: 1.4–4.8), kidney (SIR=2.5, 95% CI: 1.2–4.5), ovary (SIR=2.0, 95% CI: 1.2–3.1) and uterine tumours (SIR=1.9, 95% CI: 1.4–2.5). The SIR was 3.0 (95% CI 1.8–4.7) in women under 40 at the time of the breast cancer, 1.9 (95% CI : 1.4 – 2.4) in those aged 40–49 and 1.2 (95% CI 1.0–1.4) in those aged 50 or more. In the 2,514 women who had received radiotherapy as initial treatment without chemotherapy, the SIR for all SMN was 1.6 (95% CI: 1.1–2.3) fold higher than in those who had not received radiotherapy as initial treatment. Conclusion.In conclusion, this study confirms the increased risk of second malignancies in women treated for a breast cancer, and particularly in those who were younger at the time of treatment for breast cancer. Our results also suggest that radiotherapy may play a role in the onset of these second lesions.     

Gastroesophageal reflux disease, use of H2 receptor antagonists, and risk of esophageal and gastric cancer

Objective: The incidence of esophageal adenocarcinoma has risen rapidly in the past two decades, for unknown reasons. The goal of this analysis was to determine whether gastroesophageal reflux disease (GERD) or the medications used to treat it are associated with an increased risk of esophageal or gastric cancer, using data from a large population-based case–control study. Methods: Cases were aged 30–79 years, newly diagnosed with esophageal adenocarcinoma (n=293), esophageal squamous cell carcinoma (n=221), gastric cardia adenocarcinoma (n=261), or non-cardia gastric adenocarcinoma (n=368) in three areas with population-based tumor registries. Controls (n=695) were chosen by random digit dialing and from Health Care Financing Administration rosters. Data were collected using an in-person structured interview. Results: History of gastric ulcer was associated with an increased risk of non-cardia gastric adenocarcinoma (OR 2.1, 95% CI 1.4–3.2). Risk of esophageal adenocarcinoma increased with frequency of GERD symptoms; the odds ratio in those reporting daily symptoms was 5.5 (95% CI 3.2–9.3). Ever having used H₂ blockers was unassociated with esophageal adenocarcinoma risk (OR 0.9, 95% CI 0.5–1.5). The odds ratio was 1.3 (95% CI 0.6–2.8) in long-term (4 or more years) users, but increased to 2.1 (95% CI 0.8–5.6) when use in the 5 years prior to the interview was disregarded. Risk was also modestly increased among users of antacids. Neither GERD symptoms nor use of H₂ blockers or antacids was associated with risk of the other three tumor types. Conclusions: Individuals with long-standing GERD are at increased risk of esophageal adenocarcinoma, whether or not the symptoms are treated with H₂blockers or antacids.     

Vitamin D receptor polymorphisms and risk of colorectal adenomas (United States)

Objective: The purpose of this study was to determine whether vitamin D receptor (VDR) gene polymorphisms influence risk of colorectal adenoma. Methods: Polymorphisms in the 5 and 3 ends of the VDR gene were genotyped for 373 colorectal adenoma cases and 394 controls. Results: Overall, there was no significant association between the 5 (FokI) or the 3 (BsmI) polymorphisms and adenoma risk. However, risk of large (>1 cm) adenomas decreased with increasing copies of the FokI f allele (p = 0.04). Compared to the FF genotype, odds ratios for the Ff and ff genotypes were 0.79 (95% CI 0.44–1.41) and 0.32 (95% CI 0.11–0.91), respectively. FokI genotype was more strongly related to large adenoma risk among subjects with low dietary calcium intake (OR_Ff = 0.48; 95% CI 0.17–1.3; OR_ff = 0.21; 95% CI 0.04–1.3), low dietary vitamin D intake (OR_Ff = 0.25; 95% CI 0.09–0.69; OR_ff = 0.22; 95% CI 0.04–1.2), or dark skin color (OR_Ff = 0.66; 95% CI 0.27–1.6; OR_ff = 0.10; 95% CI 0.01–1.0). Conclusion: These results suggest that VDR FokI genotype influences development of colorectal adenomas, and that the effect may be modified by calcium and vitamin D status.     

Micronutrients and laryngeal cancer risk in Italy and Switzerland: a case-control study

Objective: To investigate the relation between various micronutrients and laryngeal cancer risk. Methods: A case–control study was conducted in Italy and Switzerland between 1992 and 2000. Cases were 527 patients with incident cancer of larynx, admitted to the major teaching and general hospitals of the study areas. Controls were 1297 subjects admitted for acute, non-neoplastic diseases to the same network of hospitals. Dietary habits were assessed using a validated food-frequency questionnaire. Odds ratios (OR) and their corresponding 95% confidence intervals (CI) were computed using multiple logistic regression. Results: Significant inverse relations emerged between laryngeal cancer risk and intake of vitamin C (OR = 0.2, for the highest versus the lowest intake quintile; 95% CI: 0.2–0.4), -carotene (OR = 0.2; 95% CI: 0.2–0.4), -carotene (OR = 0.3; 95% CI: 0.2–0.5), lutein/zeaxanthin (OR = 0.4; 95% CI: 0.3–0.6), vitamin E (OR = 0.4; 95% CI: 0.3–0.6), -criptoxanthin (OR = 0.4; 95% CI: 0.2–0.5), folic acid (OR = 0.4; 95% CI: 0.2–0.6), thiamin (OR = 0.4; 95% CI: 0.3–0.6), glutathione (OR = 0.5; 95% CI: 0.4–0.8), reduced glutathione (OR = 0.6; 95% CI: 0.4–0.8), vitamin B6 (OR = 0.6; 95% CI: 0.4–0.9) and potassium (OR = 0.6; 95% CI: 0.4–0.9). Direct associations were found with zinc (OR = 1.5; 95% CI: 1.0–2.2) and vitamin D (OR = 1.8; 95% CI: 1.2–2.6). Combining low intakes of vitamin C, carotene, vitamin E, and folate with heavy smoking and drinking led to ORs between 80 and 170. Conclusions: This study provides further support that, independently from smoking and alcohol consumption, the intake of several micronutrients, including selected antioxidants, is inversely related to laryngeal cancer risk.     

A pooled analysis of case–control studies of thyroid cancer. IV. Benign thyroid diseases

Objective: To obtain more precise estimates of the association between thyroid cancer and benign thyroid diseases and to elucidate the role of potential confounders or effect modifiers.Methods: The original data from 12 case–control studies from the United States, Asia, and Europe were pooled. Based on 2094 women and 425 men with cancer of the thyroid and, respectively, 3248 and 928 control subjects, odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were obtained by conditional regression models, conditioning on study and age at diagnosis, and adjusting for age and radiotherapy.Results: A history of hypothyroidism was not associated with cancer risk (pooled ORs=0.9, 95% confidence interval, CI: 0.7–1.3 in women and 1.7, 95% CI: 0.3–11.7 in men). ORs for hyperthyroidism were 1.4 (95% CI: 1.0–2.1) in women and 3.1 (95% CI: 1.0–9.8) in men. In women, however, risk was lower in the absence of or after allowance for history of goiter. Pooled ORs for a history of goiter were 5.9 (95% CI: 4.2–8.1) in women and 38.3 (95% CI: 5.0–291.2) in men. Risk for a history of benign nodules/adenomas was especially high (OR=29.9, 95% CI: 14.5–62.0, in women; 18 cases versus 0 controls in men). The excess risk for goiter and benign nodules/adenomas was greatest within 2–4 years prior to thyroid cancer diagnosis, but an elevated OR was present 10 years or more before cancer.Conclusions: Goiter and benign nodules/adenomas are the strongest risk factors for thyroid cancer, apart from radiation in childhood.     

Association of folate and alcohol with risk of ovarian cancer in a prospective study of postmenopausal women

Studies evaluating the association of ovarian cancer with alcohol intake are inconsistent, and few have evaluated this association in the context of folate consumption. Dietary folate and alcohol intakes and lifestyle and medical information were collected with self-administered questionnaires in 1986 from postmenopausal women aged 55–69 followed prospectively for 15 years for risk of epithelial ovarian cancer in the Iowa Women's Health Study. Among 27,205 eligible women free of baseline cancer, 147 incident epithelial ovarian cancer cases were identified by linkage to a cancer registry. Compared to the lowest quartile of total folate (food plus supplement) intake, the multivariable risk ratios (RR) for increasing quartiles were 1.0 (referent), 1.59, 1.24, 1.73 (95% confidence interval [CI], 0.90–3.33; p for trend, 0.20). Compared to non-drinkers, the RRs for increasing alcohol intake were 1.0 (referent), 0.78 for 0.01–3.9 g/d, 0.75 for 4.0–9.9 g/d and 0.58 for 10 g/d (95% CI, 0.30–1.11; p for trend, 0.08). Among women with alcohol intake 4 g/d compared to <4 g/d, the apparent risk reduction was limited to those with total folate intake 331 g/d (RR, 0.52; 95% CI, 0.22–1.19; p for interaction, 0.04) although this estimate was based on only seven cases. The association did not change appreciably when we excluded tumors of mucinous histology. These findings suggest that alcohol consumption is inversely related to postmenopausal ovarian cancer, and that the association of folate with ovarian cancer may vary by the amount of alcohol consumed.     

Calcium,vitamin D,dairy products,and risk of colorectal cancer in the Cancer Prevention Study II Nutrition Cohort (United States)

Objective: Calcium, vitamin D, and dairy product intake may reduce the risk of colorectal cancer. We therefore examined the association between these factors and risk of colorectal cancer in a large prospective cohort of United States men and women. Methods: Participants in the Cancer Prevention Study II Nutrition Cohort completed a detailed questionnaire on diet, medical history, and lifestyle in 1992–93. After excluding participants with a history of cancer or incomplete dietary information, 60,866 men and 66,883 women remained for analysis. During follow-up through 31 August 1997 we documented 421 and 262 cases of incident colorectal cancers among men and women, respectively. Multivariate-adjusted rate ratios (RR) were calculated using Cox proportional hazards models. Results: Total calcium intake (from diet and supplements) was associated with marginally lower colorectal cancer risk in men and women (RR = 0.87, 95% CI 0.67–1.12, highest vs lowest quintiles, p trend = 0.02). The association was strongest for calcium from supplements (RR = 0.69, 95% CI 0.49–0.96 for 500 mg/day vs none). Total vitamin D intake (from diet and multivitamins) was also inversely associated with risk of colorectal cancer, particularly among men (RR = 0.71, 95% CI 0.51–0.98, p trend = 0.02). Dairy product intake was not related to overall risk. Conclusions: Our results support the hypothesis that calcium modestly reduces risk of colorectal cancer. Vitamin D was associated with reduced risk of colorectal cancer only in men.     

Visual impairment and cancer: a population-based cohort study in Finland

Objectives: To describe the cancer risk pattern of Finnish persons with visual impairment.Methods: A cohort of 17,557 persons identified from the Finnish Register of Visual Impairment was followed-up for cancer through the Finnish Cancer Registry from 1983–95. The degree of visual impairment ranged from moderate low vision with visual acuity less than 0.3, to total blindness with no perception of light. The standardized incidence ratios (SIR) and 95% confidence intervals (CI) were calculated by primary site; the expected rates were based on national cancer incidence rates.Results: The SIR for overall cancer among totally blind men was 2.2 (CI=1.3–3.5) while in the entire cohort the incidence was increased by only 15% (1,255 cancers observed cf 1,093 expected). Excesses were observed inboth genders in cancers of the liver (SIR=1.8, CI=1.2–2.5) and lung (SIR=1.5, CI=1.3–1.7); in females in cancers of the stomach (SIR=1.5, CI=1.2–1.9) and the colorectum (SIR=1.3, CI=1.1–1.6); and in males incancers ofthe kidney (SIR=1.8, CI=1.1–2.6) and the eye (5.8, CI=1.9–13). The excess in lung cancer was entirely attributable to age-related macular degeneration (which is most common among smokers).Conclusions: Cancer incidence among the visually impaired tended to be increased for most cancer types. Attention should be paid to lifestyle factors underlying the observed risk increases, such as unbalanced diet.     

Serum bilirubin and 10-year mortality risk in a Belgian population

objective: The endogenous antioxidant serum bilirubin may scavenge free radicals and protect against free radical-related diseases. Methods: Using the 10-year follow-up mortality data from the Belgium Inter-university Research on Nutrition and Health (BIRNH) study the association between serum bilirubin and all-cause, cardiovascular, and cancer mortality in 5460 men and 4843 women was investigated. Results: In men, with the highest (0.6 mg/dl) compared with the lowest serum bilirubin concentration (0.2 mg/dl), the adjusted relative risk (RR) was 0.73 (95% confidence interval (CI) 0.57–0.94) for all-cause and 0.42 (95% CI 0.26–0.68) for cancer mortality. The risk for cancer mortality decreased with increasing concentrations of serum bilirubin (p for trend = 0.004) especially for non-lung cancer mortality (p for trend = 0.02). The associations persisted after adjusting for smoking. In women the associations between serum bilirubin and cancer mortality were in the same direction, but did not reach statistical significance (RR = 0.76, 95% CI 0.39–1.5). No significant associations were found between serum bilirubin and cardiovascular mortality in men and women. Conclusions: In this population high serum bilirubin, however, within normal ranges, was associated with low cancer mortality, especially in men. This may be due to the antioxidant activity of bilirubin. Measurement of serum bilirubin concentrations may contribute to cancer risk estimation.     

Genetic polymorphisms of <Emphasis Type="Italic">TGF-β</Emphasis>1 &; <Emphasis Type="Italic">TNF-β</Emphasis> and breast cancer risk

Objective. The proliferation of malignant breast epithelial cells is regulated by various stimuli including cytokines and growth factors, thus the variants of those genes may modify the breast cancer risk. To evaluate the potential influences of TGF-1 T²⁹C and TNF- A²⁵²G gene polymorphisms on breast cancer risk, a case–control study was conducted in Korea.Methods. Histologically confirmed breast cancer cases (n = 560) and controls (n=509) with no previous history of cancer were recruited from three teaching hospitals in Seoul, Korea. Genotypes were determined by PCR-CTPP (polymerase chain reaction with confronting two-pair primers) method. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression model adjusting for age, body mass index, education, parity, age at first full-term pregnancy, and family history of breast cancer. Results. The TGF-1 ²⁹C-allele containing genotypes posed an increased risk of breast cancer (OR=1.3, 95% CI=1.02–1.79), especially in postmenopausal women (OR=1.6, 95% CI=1.01–2.44). Similarly, the TNF- ²⁵²G-allele containing genotypes posed an increased risk of postmenopausal breast cancer (OR=1.7, 95% CI=1.09–2.55). The risk of postmenopausal breast cancer increased in parallel with the number of the risk genotypes (p for trend <0.01). When data were stratified by the presumed non-genetic risk factors, TGF-1 C-allele containing genotypes were found to increase breast cancer risk almost two-fold in postmenopausal women with greater than median body mass index (>22.8 kg/m²) (OR=1.9, 95% CI=1.04–3.37).Conclusion. The results of this study therefore suggest that polymorphisms of TGF-1 and TNF- genes may modify individual susceptibility to breast cancer in Korean women.     

A prospective study of body mass,height, and smoking on the risk of colorectal cancer in women

Female registered nurses in the United States who responded to a questionnaire in 1976 that inquired about height, weight, and smoking history were followed for the development of colon or rectal cancers through May of 1984. Among the 118,404 respondents free of cancer in 1976, 191 colon cancers and 49 rectal cancers were observed during 916,170 person-years of follow-up. After omitting cases diagnosed within two years of weight report, we found little overall relation of body mass (Quetelet's) index to colon cancer risk; however there was a suggestion of elevated risk for the heaviest category of body mass index (29 kg/m², relative risk (RR)=1.5; 95 percent confidence interval = 0.8–2.7) relative to the lowest category (<21 kg/m²). Self-reported body mass index from adolescence had a slightly more pronounced, although not significant, association with risk of colon cancer. Increasing height was significantly associated with colon cancer (RR=1.6, 95 percent confidence interval = 1.1–2.5 for the tallest category [168 cm] vs the shortest [<160 cm], trend P=0.04). Measures of current or past smoking failed to demonstrate any consistent relationship with colon cancer.The Nurses Health Study has been supported by research grant CA-40356 from the National Institutes of Health. Dr Chute was supported by a National Research Service Award (T32-CA09001).     

Obesity,body size,and risk of postmenopausal breast cancer: the Women's Health Initiative (United States)

OBJECTIVE: Body size is an important modifiable risk factor for breast cancer. Although obesity has generally been found to be associated with increased risk for postmenopausal breast cancer, there remain questions concerning the role of body fat distribution, lifetime weight history, and effects within specific subgroups of women.METHODS: We assessed the relationship of several anthropometric measures and risk of postmenopausal breast cancer in 85,917 women aged 50–79 at entry in the Women's Health Initiative Observational Study. Women were enrolled during 1993–1998 at 40 clinics in the US and 1030 developed invasive breast cancer by April 2000. Upon entry, trained clinical center staff measured each woman's height, weight, and waist and hip circumference.RESULTS: Anthropometric factors were not associated with breast cancer among women who had ever used hormone replacement therapy (HRT). Among HRT non-users, heavier women (baseline body mass index (BMI) > 31.1) had an elevated risk of postmenopausal breast cancer (relative risk (RR) = 2.52; 95% confidence interval (CI) = 1.62–3.93), compared to slimmer women (baseline BMI 22.6). The elevation in risk associated with increasing BMI appeared to be most pronounced among younger postmenopausal women. Change in BMI since age 18, maximum BMI, and weight were also associated with breast cancer in HRT non-users. While both waist and hip circumference were associated with breast cancer risk, their ratio, a measure of fat distribution, was not (RR = 1.33; 95% CI = 0.88–2.01).CONCLUSIONS: Our study confirms previously reported findings that generalized obesity is an important risk factor for postmenopausal breast cancer, but only among women who have never taken HRT. Lifetime weight gain is also a strong predictor of breast cancer. Waist to hip ratio, a measure of weight distribution, does not appear to be related to postmenopausal breast cancer risk.     

Birth weight,ethnicity, and occurrence of cancer in children: a population-based,incident case-control study in the State of Texas,USA

Objective: To investigate the relationship between birth weight and risk of early age childhood cancer and whether racial differences in birth weight distribution could explain differences in the incidence of cancer in white, Hispanic, and black children. Methods: We compared birth weights of 268 children younger than five years old and diagnosed with cancer in the State of Texas in 1995 to the birth weights of 2680 randomly selected, age-matched population-based controls. Birth weight, sex, race/ethnicity, maternal age, smoking status, parity, and gestational age information was ascertained from the birth certificates. Logistic regression analyses were performed to evaluate the association between high birth weight (> 4000 g) and occurrence of childhood cancer. Results: Increased odds ratios (OR) were found for total cancer cases (OR 1.4, 95% CI 0.9–2.1), leukemia cases (OR 1.7, 95% CI 0.9–3.0) and acute lymphoblastic leukemia (ALL) cases (OR 2.2, 95% CI 1.2–4.1). Increased ORs in the former two groups were shown to be due to ALL cases. Including the race/ethnicity variable in the regression model did not affect the ORs. Conclusion: Compared to newborns who weighed between 2500 and 4000 g at birth, children who weighed > 4000 g had an increased risk of developing childhood ALL during the first five years of life. Birth weight differences does not explain the sequence of childhood cancer incidence by race/ethnicity.     

A prospective cohort study of cigarette smoking and pancreatic cancer in Japan

Objective: To examine the association of cigarette smoking with the risk of death from pancreatic cancer in a prospective cohort study. Methods: A total of 110,792 inhabitants, aged 40–79 years (46,465 men and 64,327 women), were enrolled from 1988 to 1990 and followed up for mortality to the end of 1997. At baseline a self-administered questionnaire was used to obtain information on cigarette smoking and other lifestyle factors. Results: During the follow-up period (mean ± SD: 8.1 ± 1.8 years), 225 deaths due to pancreatic cancer were identified. After adjustment for age, body mass index, history of diabetes mellitus, and gallbladder diseases, the relative risks (RRs) for current smokers were 1.6 (95% CI 0.95–2.6) in males, and 1.7 (95% CI: 0.84–3.3) in females. Men who smoked more than 40 cigarettes per day had a substantially higher risk of pancreatic cancer, with a RR of 3.3 (95% CI: 1.4–8.1). A significantly decreasing trend in risk with increasing years after smoking cessation was observed (trend p = 0.04) among male ex-smokers. The RRs were 0.85 (95% CI 0.36–2.0) and 0.85 (0.36–2.0) for those who had quit smoking for 10–19 and 20 years, respectively. Conclusions: Our cohort study confirmed that cigarette smoking was associated with an increased risk of death from pancreatic cancer.     

Influences of apolipoprotein E polymorphism on the risk for breast cancer and HER2/neu status in Taiwan

Summary Apolipoprotein E (APOE) polymorphism plays an important role in lipid metabolism. Preliminary evidence suggests that APOE genotype appears to be a risk factor for not only cardiovascular disease, but also Alzheimers disease and cancer. We screened the APOE genotype in 290 breast cancer patients and 232 non-cancer controls and determined the relationship between APOE gene polymorphism and breast cancer in Taiwan. We found risk for breast cancer was associated with the APOE genotype (² = 8.652, p = 0.013). Carriers of the 4 allele were more common in breast cancer cases than carriers of 3 allele (p = 0.004, OR = 1.786, 95% CI: 1.197–2.664). In addition, the 4 allele is also associated with HER2/neu negative status in breast cancer patients (p = 0.006, OR = 0.277, 95% CI: 0.111–0.693). No significant associations between APOE genotype and tumor grade, TN classification, progesterone receptor, estrogen receptor, lymphatic invasion, or recurrence of breast cancer were in evidence. These results suggest that the APOE 4 allele may be a risk factor for breast cancer and correlates with HER2/neu negative status.