A prospective study of selenium status and breast cancer risk

Low dietary intake of selenium has been proposed as a risk factor for breast cancer. To address this hypothesis, we collected toenail clippings from 62,641 women in the Nurses' Health Study cohort who were free from cancer (other than nonmelanoma skin cancer) in 1982 and 1983. The selenium concentration in nails has been shown to reflect dietary intake of selenium. During 53 months of follow-up, 434 cases of breast cancer were diagnosed among women who had submitted a set of toenail clippings, and we matched one control free from breast and other cancers to each case. The mean selenium level in toenails in the cases (0.823 microgram/g; SD, 0.197) was almost identical to that of the controls (0.821 microgram/g; SD, 0.174). After controlling for known breast cancer risk factors, the relative risk for women in the highest quintile of selenium as compared with the lowest quintile was 1.10 (95% confidence interval, 0.70 to 1.72) and there was no trend across quintiles. Results were similar for both premenopausal and postmenopausal women. Although these data do not exclude a possible influence of selenium intake before adulthood on subsequent risk of breast cancer, selenium intake later in life is not likely to be an important factor in the etiology of breast cancer.     

Association between folate intake, serum folate levels and the risk of lung cancer: a systematic review and meta-analysis

Background Folate plays a critical role in nucleotide synthesis and DNA methylation,and was considered to be associated with anti-carcinogenesis.Results from studies that concern the relationship between the folate intake or serum folate levels and lung cancer risk showed no consistency,which requires our further comprehensive metaanalysis.Methods Systematic literature search was conducted to identify the relevant studies (published prior to February 2013)according to standard protocol.Estimated effects were calculated under both random-effects and fixed-effects models.Heterogeneity between studies and publication bias were also evaluated.Results A total of 4390 cases and 6138 controls from 6 case-control studies revealed a significant overall inverse association between folate intake and lung cancer risk (OR =0.74,95％ Cl =0.65-0.84,P＜ 0.001).Summary of 1438 cases and 2582 controls from 4 case-control studies and 44 cases out of a cohort of 1988 participants suggested a marginal association without significance (OR =0.78,95％ Cl =0.60-1.02,P =0.075) between high serum folate levels and less lung cancer susceptibility; however,subgroup analysis about population-based case-control studies showed that high serum folate levels significantly associated with the reduced lung cancer risk (OR =0.76,95％ Cl =0.58-1.00,P =0.048).Conclusion Higher folate intake can be a protective factor against lung cancer risk,and higher serum folate level is probably associated with reduced lung cancer risk in marginal manner,though more studies are warranted to confirm these associations.     

Oral contraceptives and breast cancer. A prospective cohort study

In 1976, information on oral contraceptive (OC) use as well as numerous risk factors for breast cancer was provided by 121,964 married female registered nurses aged 30 to 55 years. Ninety-two percent of women in the cohort completed follow-up questionnaires, and vital records were systematically searched to ascertain deaths among nonrespondents. After four years of follow-up, 592 incident cases of breast cancer were identified. Compared with never users, the age-adjusted relative risk (RR) of breast cancer, regardless of menopausal status, among all women who had ever used OCs was 1.0. Among premenopausal women compared with those who had never used OCs, the RR of breast cancer was 1.5 for current use of OCs in 1976 and 1.0 for past use. Among postmenopausal women, the RR for past use of OCs was 1.0. These estimates were essentially unaltered after controlling for other known risk factors for breast cancer in multiple logistic regression analysis. Furthermore, there was no modification of these effects by family history of breast cancer, age at first use, timing of the first birth, or other breast cancer risk factors. Data on past use of OCs provide substantial reassuring evidence that there is no large excess risk of breast cancer within a few years of cessation of pill use. The observed moderate elevation of breast cancer risk with current use was of borderline statistical significance. However, the observation was based on 29 cases and may reflect the effect of sampling variability, as most other studies have not observed a relationship between current use of OCs and breast cancer in women of this age.     

226例乳腺癌相关危险因素的病例对照研究

目的 探讨惠州地区女性乳腺癌发病的相关危险因素,为乳腺癌的病因研究及一级预防提供依据.方法 采用病例对照研究的方法,选取经病理学确诊为乳腺癌的患者226例,同期门诊体检的健康人群226例作为健康对照组,采用统一调查问卷调查表采集乳腺癌相关危险因素资料,进行乳腺癌危险因素单因素及多因素条件10gistics回归分析,计算各危险因素与大肠癌的关联程度OR值及其95%可信区间.结果 单因素条件10gistics回归分析发现,初潮年龄早(OR=2.064)初产年龄晚(OR=4.495)绝经年龄晚(OR=1.423)性生活不和谐(OR=4.815)饮酒(OR=14.206)吸烟(OR=16.311)口服避孕药(OR=7.267)平时容易发怒(OR=1.021)平时喜欢吃油炸食物(OR=2.52)长期穿坚硬胸罩(OR=7.267)一级亲属患乳腺癌(OR=124.586)既往有子宫肌瘤病史(OR=2.407)既往有卵巢囊肿病史(OR=6.089)及肝炎病史(OR=1.143)是乳腺癌发病的危险因素,哺乳时间长(OR=0.046)及既往有乳腺增生病史(OR=2.308)是乳腺癌发病的保护因素;多因素条件10gistics回归分析发现,初潮年龄早(OR=16.769)初产年龄晚(OR=1.193)饮酒(OR=3.272)吸烟(OR=2.080)一级亲属患乳腺癌(OR=13.146)既往有子宫肌瘤病史(OR=5.890)及卵巢囊肿病史(OR=2.631)是乳腺癌发病的危险因素.结论 初潮年龄早、初产年龄晚、饮酒、吸烟、一级亲属患乳腺癌、既往有子宫肌瘤病史及卵巢囊肿病史是乳腺癌发病的危险因素;而哺乳时间长及既往有乳腺增生病史是乳腺癌发病的保护因素.     

Association of dietary intake of fat and fatty acids with risk of breast cancer

Context  High intakes of fat and specific fatty acids, including total, animal, saturated, polyunsaturated, and trans-unsaturated fats, have been postulated to increase breast cancer risk. Objective  To determine whether intakes of fat and fatty acids are associated with breast cancer. Design and Setting  Cohort study (Nurses' Health Study) conducted in the United States beginning in 1976. Participants  A total of 88,795 women free of cancer in 1980 and followed up for 14 years. Main Outcome Measure  Relative risk (RR) of invasive breast cancer for an incremental increase of fat intake, ascertained by food frequency questionnaire in 1980, 1984, 1986, and 1990. Results  A total of 2956 women were diagnosed as having breast cancer. Compared with women obtaining 30.1% to 35% of energy from fat, women consuming 20% or less had a multivariate RR of breast cancer of 1.15 (95% confidence interval [CI], 0.73-1.80). In multivariate models, the RR (95% CI) for a 5%-of-energy increase was 0.97 (0.94-1.00) for total fat, 0.98 (0.96-1.01) for animal fat, 0.97 (0.93-1.02) for vegetable fat, 0.94 (0.88-1.01) for saturated fat, 0.91 (0.79-1.04) for polyunsaturated fat, and 0.94 (0.88-1.00) for monounsaturated fat. For a 1% increase in energy from trans-unsaturated fat, the values were 0.92 (0.86-0.98), and for a 0.1% increase in energy from omega-3 fat from fish, the values were 1.09 (1.03-1.16). In a model including fat, protein, and energy, the RR for a 5% increase in total fat, which can be interpreted as the risk of substituting this amount of fat for an equal amount of energy from carbohydrate, was 0.96 (95% CI, 0.93-0.99). In similar models, no significant association of risk was evident with any major types of fat. Conclusion  We found no evidence that lower intake of total fat or specific major types of fat was associated with a decreased risk of breast cancer.      

脑卒中患者复发及其影响因素研究

目的 探讨脑卒中后1年复发率及其主要影响因素.方法 基于华西医院卒中登记数据库,前瞻性随访卒中患者病后1年的复发情况,并登记影响卒中复发的各种可能因素,采用Logistic回归模型对这些因素进行分析.结果 2002年3月至2005年9月,共纳入1913例卒中患者,其中脑出血599例(31.3%),缺血性脑卒中1314例(68.7%).卒中1年的总体复发率为11.2%,其中脑梗死为10.5%,脑出血为12.7%.校正年龄和性别后,多因素分析显示房颤、高脂血症、脑卒中家族史、高血压、吸烟是脑卒中复发的独立危险因素.结论 脑卒中后1年复发率约为11%,应加强脑卒中患者房颤、高脂血症、高血压、吸烟的监测和预防.以减少卒中再发.     

鱼的摄入与肾癌发病风险关系的Meta分析

目的应用meta分析的方法对各项研究进行系统分析以研究鱼的摄入与肾癌发病风险关系。方法在PubMed,Embase,
CNKI,CA中检索有关鱼及其产品的摄入与肾癌关系的病例对照研究以及队列研究的文献。通过meta分析方法研究鱼的摄入
与肾癌的关系。运用I2检验各项研究的异质性,并使用漏斗图检验发表偏倚。结果共纳入17篇文献,采用随机效应模型合并
分析后的结果未发现鱼的摄入与肾癌的发病风险相关（RR=0.90;95% CI,0.78~1.02）且异质性明显（P=0.003,I2=52.3%）,针对
研究类型、研究地区以及发表时间进行亚组分析,同样没有明显的证据证明两者相关,但在性别亚组的分析中发现,男性增加鱼
的摄入可降低肾癌的发病率,而在女性中则没有关系。结论meta分析结果提示增加鱼的摄入未发现有预防肾癌发病的作用。
     

没有证据显示补充叶酸会增加罹患癌症的风险

为确定补充叶酸与某些类型癌症之间的关系,研究者对13项安慰剂对照研究的数据进行了分析。数据合并后所获得的分析结果让人松了一口气。那些补充叶酸的受试者在接受平均5年的随访期间,与对照组相比,其罹患癌症的几率并未增加（补充叶酸组的受试者中有1904例患癌症,而安慰剂组中有1809例患病,相对危险度为1．06,95％ CI：0．99-1．13）。受试者单独补充叶酸或与维生素B联合使用,剂量为每日0．5～5．0mg。研究者未发现任何一种癌症类型与补充叶酸有关系,也未发现罹患癌症的风险与补充叶酸时间长短有关。     

Dietary fiber intake and risk of colorectal cancer: a pooled analysis of prospective cohort studies

Context  Inconsistent findings from observational studies have continued the controversy over the effects of dietary fiber on colorectal cancer. Objective  To evaluate the association between dietary fiber intake and risk of colorectal cancer. Design, Setting, and Participants  From 13 prospective cohort studies included in the Pooling Project of Prospective Studies of Diet and Cancer, 725 628 men and women were followed up for 6 to 20 years across studies. Study- and sex-specific relative risks (RRs) were estimated with the Cox proportional hazards model and were subsequently pooled using a random-effects model. Main Outcome Measure  Incident colorectal cancer. Results  During 6 to 20 years of follow-up across studies, 8081 colorectal cancer cases were identified. For comparison of the highest vs lowest study- and sex-specific quintile of dietary fiber intake, a significant inverse association was found in the age-adjusted model (pooled RR = 0.84; 95% confidence interval [CI], 0.77-0.92). However, the association was attenuated and no longer statistically significant after adjusting for other risk factors (pooled multivariate RR = 0.94; 95% CI, 0.86-1.03). In categorical analyses compared with dietary fiber intake of 10 to <15 g/d, the pooled multivariate RR was 1.18 (95% CI, 1.05-1.31) for less than 10 g/d (11% of the overall study population); and RR, 1.00 (95% CI, 0.85-1.17) for 30 or more g/d. Fiber intake from cereals, fruits, and vegetables was not associated with risk of colorectal cancer. The pooled multivariate RRs comparing the highest vs lowest study- and sex-specific quintile of dietary fiber intake were 1.00 (95% CI, 0.90-1.11) for colon cancer and 0.85 (95% CI, 0.72-1.01) for rectal cancer (P for common effects by tumor site = .07). Conclusions  In this large pooled analysis, dietary fiber intake was inversely associated with risk of colorectal cancer in age-adjusted analyses. However, after accounting for other dietary risk factors, high dietary fiber intake was not associated with a reduced risk of colorectal cancer.      

A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer

Background Breast conserving surgery （BCS） has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy （ESM） plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting. Methods From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. Results There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups （P 〉0.05）. The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM （88.4%, 38/43） and BCS （92.6%, 50/54） patients （P 〉0.05）. During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence -- one of these patients died of multiple organ metastasis. Conclusions After considering the wide indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants -- the new surgery of choice for breast cancer -- warrants serious consideration as the prospective next standard surgical procedure.     

浙江地区女性乳腺癌危险因素的病例对照研究

目的:探讨浙江地区女性乳腺癌危险因素,为有效防治乳腺癌提供科学依据。方法:采用1∶1配对的病例对照研究方法,对经病理确诊的200例女性乳腺癌患者及200例匹配对照进行条件logistic回归分析。结果:单因素logistic回归分析显示:恶性肿瘤家族史、乳腺癌家族史、其它肿瘤家族史、近十年有大型装修、乳腺增生、负性生活事件(工作、亲友病故)、文胸含钢圈、睡觉戴文胸、常食肥肉和腌制品、睡眠质量差等能增加乳腺癌的发生;而环保型装饰材料、装修与入住间隔时间长、工作单位性质、哺乳和分娩次数多、常吃水果、充足的睡眠则能降低相关风险性。多因素logistic分析显示有意义的危险因素有:其它肿瘤家族史(OR=1.571,95%CI:1.029～2.396)、乳腺增生(OR=3.066,95%CI:1.834～5.126)、工作负性事件(OR=4.575,95%CI:1.690～12.390)、亲友病故(OR=2.555,95%CI:1.475～4.424)、睡觉戴文胸(OR=1.902,95%CI:1.177～3.072)、常吃肥肉(OR=2.709,95%CI:1.546～4.749)和腌制品(OR=2.460,95%CI:1.300～4.653);保护因素有:装修用环保材料(OR=0.517,95%CI:0.339～0.789)、工作单位性质(OR=0.430,95%CI:0.243～0.762)、哺乳数(OR=0.109,95%CI:0.013～0.896)、充足的睡眠时间(OR=0.424,95%CI:0.205～0.880)。结论:浙江地区女性乳腺癌危险因素中,遗传、精神心理、生育、个人习惯、环境、饮食等相关因素起着重要作用,乳腺癌的发生和发展是多种因素作用的结果,因此需要采取综合措施才能有效控制乳腺癌。     

Adipocytokines and breast cancer risk

Background Many researches suggested that obesity increased the risk of breast cancer, but the mechanism was currently unknown. Adipocytokines might mediate the relationship. Our study was aimed to investigate the relationship between serum levels of resistin, adiponectin and leptin and the onset, invasion and metastasis of breast cancer. Methods Blood samples were collected from 80 newly diagnosed, histologically confirmed breast cancer patients and 50 age-matched healthy controls. Serum levels of resistin, adiponectin and leptin were determined by enzyme-linked immunosorbent assays (ELISA); fasting blood glucose (FBG), lipids, body mass index (BMI), and waist circumference (WC) were assayed simultaneously.Results Serum levels of adiponectin ((8.60±2.92) mg/L vs (10.37±2.81) mg/L, P=0.001) and HDL-c were significantly decreased in breast cancer patients in comparison to controls. Serum levels of resistin ((26.35±5.36) μg/L vs (23.32±4.75) μg/L, P=0.000), leptin ((1.35±0.42) μg/L vs (1.06±0.39) μg/L, P=0.003), FBG and triglyceride (TG) in breast cancer patients were increased in contrast to controls, respectively. However, we did not find the significant difference of the serum levels of resistin, adiponectin and leptin between premenopausal breast cancer patients and healthy controls (P＝0.091, 0.109 and 0.084, respectively). The serum levels of resistin, adiponectin and leptin were significantly different between patients with lymph node metastasis (LNM) and those without LNM (P=0.001, 0.000 and 0.006, respectively). The stepwise regression analysis indicated that the tumor size had the close correlation with leptin (R(2)=0.414, P=0.000) and FBG (R(2)=0.602, P=0.000). Logistic regression analysis showed that reduced serum levels of adiponectin (OR: 0.805; 95%CI: 0.704–0.921; P＝0.001), HDL (OR: 0.087; 95%CI: 0.011–0.691, P＝0.021), elevated leptin (OR: 2.235; 95%CI:1.898–4.526; P＝0.004) and resistin (OR: 1.335; 95%CI: 1.114–2.354; P＝0.012) increased the risk for breast cancer; Reduced serum levels of adiponectin (OR: 0.742; 95%CI: 0.504–0.921; P=0.003) and elevated leptin (OR: 2.134; 95%CI:1.725–3.921; P= 0.001) were associated with lymph node metastasis of breast cancer. Conclusions The decreased serum adiponectin levels and increased serum resistin and leptin levels are risk factors of breast cancer. The low serum adiponectin levels and high serum leptin levels are independent risk factors for metastasis of cancer. The association between obesity and breast cancer risk might be explained by adipocytokines.     

Prolactin and breast cancer risk

A study of 424 women was undertaken to determine whether there was an association between serum prolactin levels and breast cancer; whether prolactin levels would reflect degrees of risk of developing breast cancer; and whether associations between known risk factors for breast cancer and serum prolactin concentrations could be demonstrated. Prolactin levels higher than the median value in control subjects were found to be associated with a more than two-fold increase in the risk of breast cancer (relative risk, 2.1; confidence interval [CI], 1.0-4.5). Moreover, a relative risk of 1.7 (CI, 0.9-3.3) for a group of women with benign epithelial hyperplasia (high risk of developing breast cancer), and a relative risk of 1.0 (CI, 0.6-1.8) for a group with benign fibrocystic disease (low risk of developing breast cancer), provided supportive evidence that prolactin plays a role in the development of breast cancer. A considerable fall in the concentration of prolactin at menopause was noted, so those women who have an early menopause have a reduced period of exposure to high concentrations of prolactin. Similarly, there was a considerable reduction in prolactin concentration after the first pregnancy. Finally, our results showed that, in premenopausal women, a high intake of saturated fats was associated with a high prolactin concentration. Our study supports the concept that parity, menstrual status, and saturated fat consumption influence a woman's exposure to prolactin and therefore the risk of developing breast cancer.     

环京津地区妇女乳腺恶性肿瘤风险分析的初步研究

目的：尝试建立初步评价模型,预测环京津地区妇女乳腺恶性肿瘤风险。方法：通过对该地区乳腺恶性肿瘤危险因素的调查及筛选,得到乳腺恶性肿瘤风险评价模型,利用ROC曲线比较该模型和Gail模型在该地区针对危险度评价的效果。结果：环京津地区女性患乳腺恶性肿瘤的可能危险因素中影响最突出的是：年龄、体重指数＞25 kg/m2、一级亲属患乳腺恶性肿瘤、因不良生活事件或情绪调节能力差导致长期不良情绪、睡眠质量差、终生未妊娠、吸烟指数＞400、致密型乳腺。本研究建立的模型预测环京津地区妇女乳腺恶性肿瘤准确性高于Gail模型。结论：针对危险因素,建立初步模型,有可能更好地预测患者罹患乳腺恶性肿瘤的风险。     

改良乳腺癌手术与传统乳腺癌手术的临床对比研究

目的 研究改良乳腺癌手术与传统乳腺癌手术的效果差异.方法 选取乳腺癌患者98例为研究对象,随机将患者分成对照组和观察组,各49例.对照组患者给予传统乳腺癌手术治疗,观察组患者给予改良乳腺癌手术治疗,对比两组患者的手术时间、术中出血量、并发症发生率、住院时间等指标值.结果 观察组患者的术中出血量少于对照组,且手术时间、引流时间和住院时间比对照组短,两组比较差异具有统计学意义(P<0.05);观察组患者的并发症发生率6.12%低于对照组22.45%,两组比较差异具有统计学意义(P<0.05).结论 改良乳腺癌手术比传统乳腺癌手术更具优势,手术创伤小,患者术后恢复快,值得在临床上推广应用.