Serum lipids and breast cancer risk: a cohort study of 5,207 Danish women

The association between serum lipids and breast cancer risk was investigated in a cohort of 5,207 Danish women, who participated in The Glostrup Population Studies between 1964 and 1986. During four to 26 years of follow-up, 51 incident cases of breast cancer were identified by linkage to the Danish Cancer Registry. At the time of lipid measurement, the women were between 30 and 80 years of age. An inverse association was found between serum high-density lipoprotein (HDL) cholesterol and risk of breast cancer, which was not changed by adjustment for potential confounders such as social class, age at menarche and menopause, number of full-term pregnancies, body mass index, or alcohol and coffee consumption. The relative risk was 0.3 (95 percent confidence interval = 0,1–0.8) for women in the highest quartile of serum HDL-cholesterol compared with women in the lowest quartile and the relation displayed a significant negative trend (P = 0.01). For serum triglycerides there was a suggestion of a positive association with breast cancer incidence, but the trend was not significant (P = 0.06). No relationship between total serum cholesterol or low-density lipoprotein cholesterol and risk of breast cancer was observed. Risk estimates for well known breast cancer risk factors such as social class, age at menopause, number of full-term pregnancies, and obesity were in the directions expected.Dr Høyer and Ms Engholm are with the Danish Cancer Registry, Copenhagen, Denmark; Dr Høyer is also with The Glostrup Population Studies, Glostrup, Denmark. Address correspondence to Dr Høyer at The Danish Cancer Registry, Institute of Cancer Epidemiology, Danish Cancer Society, Rosenvangets Hovedvej 35, DK-2100 Copenhagen Ø, Denmark. This study was funded by Sygekassernes Helsefond DK, Sundhedspuljen DK and the Danish Cancer Society.     

Testicular cancer, cryptorchidism, inguinal hernia, testicular atrophy, and genital malformations: case-control studies in Denmark

To explore risk factors for testicular cancer and cryptorchidism, two parallel case-control studies were conducted in Denmark. The testicular cancer study was population-based and included 514 cases and 720 controls. The cryptorchidism study included 387 cases and 416 controls and was based on two hospital series of men treated for cryptorchidism and a control group sampled among residents in the Copenhagen area. The 2,037 men were interviewed by telephone. The relative risk (RR) of testicular cancer in men with treated or persisting cryptorchidism was 3.6 (95 percent confidence interval = 1.8–6.9), but no increase in risk was seen in the six to seven percent of the men who reported a history of undescended testes that descended spontaneously. The RR in men who were treated for cryptorchidism increased with age at treatment. This effect may be due wholly or in part to increased treatment of boys with testes that would have descended spontaneously if they had not been treated. Cryptorchidism and inguinal hernia may be confused and reported interchangeably. In the absence of cryptorchidism or testicular atrophy, clinical inguinal hernia was not associated with testicular cancer. Testicular atrophy was associated with both testicular cancer and cryptorchidism. Associations with other congenital malformations were few and based on small numbers.Henrik Møller is at the Center for Research in Health and Social Statistics, Copenhagen, Denmark. Authors were also affiliated with The Danish Cancer Registry at The Danish Cancer Society, Copenhagen, Denmark (Drs Møller and Prener), and with International Agency for Research on Cancer, Lyons, France (Dr Møller). Dr Skakkebak is with the Department ofGrowth and Reproduction, National University Hospital, Copenhagen, Denmark. Address correspondence to Dr Møller, Center for Research in Health & Social Studies, Sejrøgade II, DK-2100 Copenhagen, Denmark. The study was supported by grants from The Danish Cancer Society and The Danish Medical Research Council.     

Smoking and breast cancer risk in Denmark

The effect of smoking on breast cancer risk was evaluated in a population-based case-control study, including 1,480 women diagnosed with breast cancer in Denmark between 1983–84. They were identified from the files of the nationwide clinical trial of the Danish Breast Cancer Cooperative Group and the Danish Cancer Registry. The control group was an age-stratified sample of 1,332 women from the general population. Data on risk factors were collected by self-administered questionnaires. The risk of breast cancer among current smokers and ex-smokers was similar to that in non-smokers, both risk estimates being close to unity. No dose-response relation was observed for any measure of smoking (age at start, duration, number of cigarettes per day, or cigarette-years of exposure) in all subjects, and when pre- and post-menopausal women were examined separately. These findings suggest that smoking is not associated with the risk of breast cancer.This work was undertaken during tenures of fellowships awarded to Dr. M. Ewertz by the Danish Cancer Society and the International Agency for Research on Cancer. The study was funded by the Danish Cancer Society, the Danish Medical Research Council, and Astrid Thaysens Legat.Dr Ewertz is with the Danish Cancer Registry, Institute of Cancer Epidemiology, Danish Cancer Society, Rosenvaengets Hovedvej 35, Box 839 DK-2100 Copenhagen Ø, Denmark.     

Cancer of the lung and urinary bladder in Denmark, 1943–87: a cohort analysis

National data from 1943 to 1987 on the two most frequent tobacco-related cancers in Denmark, lung and bladder cancer, were analyzed with multiplicative Poisson models. The temporal trends in the cohort-specific risks for both sites and sexes were similar: the risks increased in the beginning of the period covered by the analysis, but then levelled off; and there was no increase among cohorts born aftercirca 1930. Women experienced a smaller increase during the period covered by the analysis in the cohort-specific risk for bladder cancer than men (3.7cf 6.1 times), whereas the overall increase in lung-cancer cohort-specific risk was the same for both sexes. The difference could not be explained by trends in tobacco consumption, types of tobacco consumed, or occupational exposures. On the basis of these findings, it is suggested that women may be less susceptible than men to developing bladder cancer from tobacco smoking.Authors are with the Danish Cancer Registry, Institute of Cancer Epidemiology, Danish Cancer Society, Rosenvængets Hovedvej 35, Box 839, DK-2100 Copenhagen Ø, Denmark. Address correspondence to Dr Skov.     

Alcohol consumption and breast cancer risk in Denmark

The influence of alcohol consumption on breast cancer risk was evaluated in a population-based case-control study, including 1,486 cases diagnosed over a one-year (1983–84) period in Denmark. Cases were identified from the files of the nationwide clinical trial of the Danish Breast Cancer Cooperative Group and the Danish Cancer Registry. The control group was an age-stratified random sample of 1,336 women from the general population. Data on risk factors were collected by self-administered questionnaires. The association of alcohol consumption with breast cancer risk varied with age and dietary fat intake. Among women aged 50–59 years, with a fat intake in the lowest quartile, the risk of breast cancer increased with increasing consumption of alcohol. A consumption of 24 g or more per day was associated with an 18-fold increased risk compared with abstainers. For women in other age groups, alcohol consumption had no significant association with breast cancer risk.The author is with the Danish Cancer Registry, Institute of Cancer Epidemiology, Danish Cancer Society, Rosenvaengets Hovedvej 35, Box 839 DK-2100 Copenhagen Ø, Denmark. The study was funded by The Danish Cancer Society, the Danish Medical Research Council, and Astrid Thaysen's Legat.     

Diuretics may increase risk of renal cell carcinoma

The risk for kidney cancer was examined in a Danish cohort of 192,133 people on a hospital discharge register who had been given a diagnosis of hypertension, heart failure, or edema, and were presumed to be probable users of diuretics. The subjects were identified from 1977 to 1987 and followed-up for cancer through 1987. A total of 10,630 cancers was observed. While the risk for all cancers was increased slightly (standard mortality ratio [SMR]=122, 95 percent confidence interval [CI]=120–124), the risk for renal cell carcinoma was more than doubled (SMR_men=221, CI=192–253; SMR_women=246, CI=213–283). Increased risks were found in all age groups, and, although surveillance bias was present initially, the risk increased consistently in the years following discharge. Risk estimates for individuals discharged with hypertension were similar to those for the total cohort. Use of diuretics was validated in a random sample of 100 individuals. More than 70 percent were taking diuretics at the time of discharge. The increased risk for renal cell carcinoma in this cohort may indicate either that diuretics are involved in the etiology of renal cell carcinoma or that the risk can be attributed to confounders, including smoking, which affect risk for both the discharge diagnosis and renal cell carcinoma.Authors are with the Danish Cancer Registry, Danish Cancer Society, Rosenvængets Hovedvej 38, Box 839 Copenhagen DK-2100ø, Denmark. Address correspondence to Dr Mellemgaard.     

Herpes simplex virus type 2 infection and cervical cancer: a prospective study of 12 years of follow-up in Finland

This study was initiated to investigate the role of past herpes simplex virus type 2 (HSV-2) infection, as determined by serum antibody analysis, in the etiology of cervical neoplasia. Two Finnish registers, the registry of the Social Insurance Institution's Mobile Clinic Survey and the Finnish Cancer Registry, were linked. About 40,000 blood samples were drawn in 1968–72 and stored by the Social Insurance Institution. According to the Cancer Registry, 32 cases of cervical carcinoma or carcinoma in situ for which serum samples were available were diagnosed in this cohort during a follow-up of 12 years (1968–81). The serum samples of these individuals and age matched controls (2:1) from the cohort were analyzed for HSV-2 antibodies. HSV-2 infection as determined by the best available HSV-2 type-specific antibody assay, glycoprotein gG2-ELISA, was not related to cervical neoplasia, i.e., the risk of cervical neoplasia among the HSV-2 positive women was not higher than that among the negative ones (smoking-adjusted relative risk = 0.5, 95 percent confidence interval = 0.2–1.6). The results do not support the hypothesis that HSV-2 is an etiologic agent for cervical neoplasia.Drs Lehtinen, Aaran, and Leinikki are with the Department of Biomedical Science, University of Tampere, Finland. Dr Hakama is with the Department of Public Health, University of Tampere, Finland, and also, with Dr Teppo, at the Finnish Cancer Registry, Helsinki, Finland. Drs Aromaa, Knekt, and Maatela are with the Social Insurance Institution, Helsinki, Finland. Dr Peto is at the University of Oxford, Oxford, UK. Address correspondence to Dr Lehtinen, Department of Biomedical Sciences, University of Tampere, SF-33101 Tampere, Finland.     

Multiple myeloma among Danish women: employment history and workplace exposures

To investigate the role of employment history and workplace exposures as risk factors for multiple myeloma among women, a population-based case-control study using the Danish Cancer Registry data linkage system was conducted. All cases of myeloma diagnosed in Danish women between 1970 and 1984 (1,010 cases) and 4,040 age-matched women alive at the time of case-diagnosis were identified. Industrial histories from 1964 forward were obtained from the nationwide Pension Fund for 363 cases and 1,517 controls, and the most recent occupation on the tax record was available for 607 cases and 2,596 controls. Using industry/occupational-code combinations for the cases and controls who had industry employment, Danish industrial hygienists assessed the likelihood of exposure to 47 workplace substances. An increased myeloma risk (odds ratio [OR] = 1.2, 95 percent confidence interval [CI] = 1.0–1.5) was seen for women not in the Pension Fund, but who had an occupational title coded as Mrs/homemaker. Nonsignificantly elevated risks of 1.3 or greater were observed for employment in: production of agricultural products; orchards/nurseries; spinning/weaving; other textile and plastics manufacturing; hotel, entertainment, and social services industries. Elevated, but nonsignificant risks were observed for possible and probable exposure to exhaust fumes, formaldehyde, wood dust, animals or animal products, and pesticides. The strongest association with myeloma was employment in the agricultural industry (OR = 1.5, CI = 0.8–2.8), however, the number of women who worked on family farms was unknown and could not be included in this risk estimate.Drs Pottern, Heineman, and Blair are with the Occupational Studies Section, Environmental Epidemiology Branch, National Cancer Institute, USA. Dr Olsen is with the Danish Cancer Registry, Institute of Cancer Epidemiology, Copenhagen, Denmark. Dr Raffn, at the Danish Cancer Registry at the time of the study, is currently at Rigs Hospitalet, Arbedjdsmedicinsk Klinisk, Copenhagen, Denmark. Address correspondence to Dr Pottern, Occupational Studies Section, Environmental Epidemiology Branch, National Cancer Institute, EPN 418, Bethesda, MD 20892, USA.     

Incidence of cancer of oesophagus, cardia and stomach in Denmark.

Subtypes of oesophageal and gastric cancer in Denmark are compared with respect to their occurrence in men and in women, and in the Danish capital, Copenhagen, versus the rest of Denmark. Three categories of tumours can be distinguished epidemiologically: oesophageal squamous carcinoma, oesophageal and cardial adenocarcinoma, and distal gastric cancer. Comparison of information reported to the Danish Cancer Registry and cause of death as indicated on death certificates suggests that considerable misclassification between subtypes of tumours occurs. The Danish experience supports the findings from other populations of increasing incidence of oesophageal and cardial adenocarcinoma, but because of possible changes in diagnoses over time and of misclassification of subtypes, the data must be interpreted with caution.     

Parity,age at first birth and the risk of carcinoma in situ of the breast

Epidemiological studies of in situ breast cancer are sparse, and the role of reproductive history, an established risk modifier for invasive breast cancer, remains incompletely investigated. To examine possible associations with parity and age at first birth, we undertook a case-control study nested in a nationwide cohort of Swedish women. The reproductive history of 1,368 women aged 65 or younger with a diagnosis of carcinoma in situ of the breast were compared with that of 6,837 age-matched controls drawn randomly from a population-based Fertility Registry. Statistical analyses were performed by conditional logistic regression. Compared to nulliparous women, ever-parous women were at a reduced risk of carcinoma in situ of the breast. The risk decreased with number of live births, with the estimated risk reduction in the highest parity group (5+), being of the same magnitude as that reported for invasive breast cancer. By contrast, a positive association with increasing age at first birth was somewhat less pronounced than that observed previously in the same data set with respect to invasive breast cancer. Our findings indicate that parity affects the risk of invasive breast cancer and carcinoma in situ similarly, whereas the effect of age at first birth appears to be weaker for the risk of carcinoma in situ. Int. J. Cancer 77:330–332, 1998. © 1998 Wiley-Liss, Inc.     

Using central cancer-registry data to monitor progress in early detection of breast and cervical cancer (Illinois,United States)

Cases of breast and cervical cancer account for almost 40 percent of all cancers diagnosed in Illinois (United States) women. Information on screening rates, however, is not collected routinely for the populations at risk. This paper reports on surveillance indicators designed to identify target populations and evaluate programs. All cases of cancers of the breast (n=38,824, including in situ) and invasive cervix (n=2,763) with a known stage, among women aged 40 to 74, were identified through the population-based Illinois State Cancer Registry for 1986 to 1992. The proportion of breast cancer cases with in situ disease-stage and cervical cancer cases with a late invasive stage were selected as surveillance indicators. Differences by age and race were evaluated, as were age-and race-specific trends. The data suggest that Black women, aged 40 to 74 years, and White women, aged 65 to 74 years, should be targeted for breast-cancer-screening interventions. All women, aged 40 to 74, should be targeted for enhanced cervical-cancer-screening interventions. Significant trends in in situ breast cancer diagnoses were apparent in all age-race groups, however no significant decline in invasive cervical cancer was found for any age-race group. The indicators identified the age- and race-specific disparities among potential target populations for breast and cervical cancer screening.The work was supported in part by a grant from the Centers for Disease Control and Prevention, number U57/CCU508384.     

Changing mortality from esophageal cancer in males in Denmark and other European countries,in relation to changing levels of alcohol consumption

Age-specific mortality rates from esophageal cancer in men are considered by year of birth in European countries with different levels of alcohol consumption. In countries with high and increasing levels of alcohol consumption (Denmark, Hungary, Federal Republic of Germany, and Czechoslovakia) successive birth cohorts born after about 1910 experience increasing mortality from esophageal cancer in all age-groups. No clear trend in esophageal cancer mortality was observed in countries starting from lower levels of alcohol consumption, even in the presence of increasing consumption (Sweden, Norway, Finland, Netherlands, Poland, UK). There was an apparent rhreshold around 8 1 of ethanol per capita per year. Likewise, no upward trend in esophageal cancer mortality was observed in countries with high and stable alcohol consumption (France, Italy, Portugal). These findings are in agreement with results of analytic epidemiologic studies which indicate that esophageal cancer mortality is only slightly affected by moderate doses of alcohol, but rises steeply with consumption of large quantities. The incidence and mortality of esophageal cancer is likely to increase further in the future in countries where the level of alcohol consumption was relatively high in 1960 and where consumption increased further in the 1960s and 1970s.Drs Møller and Møller Jensen are with the Danish Cancer Registry, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. Drs Boyle and Maisonneuve are in the Unit of Analytic Epidemiology, International Agency for Research on Cancer, Lyons, France. Dr La Vecchia is at the Mario Negri Institute for Pharmacological Research, Milan, Italy. Address reprint requests to Dr Henrik Møller at Rosenvaengets Hovedvej 35, Box 839, Copenhagen, Denmark. This work was conducted within the framework of the SEARCH program of the International Agency for Research on Cancer. Dr La Vecchia was supported by the CNR (Italian National Research Council) Applied Project Oncology, the Italian League Against Tumours, and the Italian Association for Cancer Research, Milan.     

Decreasing rates of cervical cancer among American Indians and Hispanics in New Mexico (United States)

Minority women in New Mexico (United States)—including American Indian and Hispanic women—have shown disproportionately high incidence rates of invasive cervical cancer during the 1960s and 1970s. Several public health programs in New Mexico were directed toward early detection of cervical cellular abnormalities, particularly targeting the state's minority women. To evaluate the effectiveness of these programs, we examined the New Mexico Surveillance, Epidemiology, and End Results (SEER) data collected from 1969–92, and calculated average annual, age-specific, and age-adjusted incidence rates by ethnic group (American Indian, Hispanic, and non-Hispanic White) for five-year time intervals. We also calculated age-adjusted mortality rates for cervical cancer in the same ethnic groups using state vital records. Age-adjusted incidence rates for invasive cervical cancer show substantial temporal decreases, especially for minority women in the state. The age-adjusted incidence rate decreased by 66 percent, from 30.3 to 10.3 per 100,000 for American Indian women, and by 61 percent, from 26.1 to 10.2 per 100,000 for Hispanic women. A stage shift to earlier stages of cervical neoplasia occurred over the study period, with a substantially higher proportion of in situ compared with invasive cancers diagnosed in the most recent cf the most remote time period. The ratio of incidence rates of in situ to invasive cancers changed dramatically for both American Indian and Hispanic women. Cervical cancer mortality rates decreased steadily among Hispanic women from 1958 to 1992; the decrease among American Indian women was less stable and fluctuated due to small numbers. Ongoing targeted sceening programs should help to reduce cervical cancer incidence and mortality further in New Mexico.Drs Chao, Becker, Jordan, Darling, Gilliland, and Key are with the New Mexico Tumor Registry/Epidemiology and Cancer Control Program, Albuquerque, NM, USA. Dr Jordan and also Dr Key are with the Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM. Address correspondence to Dr Chao, New Mexico Tumor Registry, University of New Mexico Cancer Research and Treatment Center, 900 Camino de Salud NE, Albuquerque, NM, 87131-5306, USA.     

Risk of lung cancer in pre- and post-menopausal women with ano-genital malignancies

Women diagnosed during the period 1943–1990 and reported to the Danish Cancer Registry with invasive squamous-cell carcinomas of the uterine cervix, vulva, vagina or anus, together with those having pre-cancerous lesions (CIN III or carcinoma in situ) of the uterine cervix diagnosed in the period 1958–1990, were followed for the occurrence of subsequent lung cancer over 762,000 person-years. Overall, these patients developed 2 to 2° times more lung cancers than women in the general Danish population. Women in whom cervical cancer was diagnosed recently, and before the age of 45 years, had a 4.6 times elevated risk of developing lung cancer, while young women with vulvar or vaginal cancer were at a 4.0-fold elevated risk. Similarly, women in whom anal cancer was diagnosed before the age of 60 years were at a 3.5-fold increased risk of developing lung cancer. The present study supports the hypothesis that smoking is involved in the aetiology of ano-genital malignancies. The particularly high risk of developing subsequent lung cancers seen in women who were pre-menopausal (<45 years) at the time of the ano-genital cancer diagnosis suggests that the effect of smoking in ano-genital carcinogenesis might be partly mediated through alterations in oestrogen metabolism. Alternatively, patients who developed their initial ano-genital cancer at a young age might harbour some genetic susceptibility which could explain their excess lung-cancer risk. © 1995 Wiley-Liss, Inc.     

Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark

Polymyositis and dermatomyositis (PM/DM) have been associated with cancer, although the long-term risks are poorly understood. To evaluate the risk of cancer by time periods subsequent to PM/DM diagnosis, a cohort of 539 patients hospitalized with PM/DM in Denmark between 1977 and 1989 was identified from the Danish Central Hospital Discharge Register. Cancer incidence among cohort members was ascertained by linkage to the Danish Cancer Registry using a unique personal-identification number. The overall cancer risk was elevated significantly among patients with DM (standardized incidence ratio [SIR]=3.8, 95 percent confidence interval [CI]=2.6–5.4) and to a lesser extent PM (SIR=1.7, CI=1.1–2.4). Significant excesses were observed for cancers of lung, ovary, and lymphatic and hematopoietic system. However, the excess cancer incidence declined steadily with increasing years since initial diagnosis of PM/DM. The cancer risk was increased about sixfold (SIR=5.9, CI=3.8–8.7) during the first year, but was lower during the second year (SIR=2.5, CI=1.1–4.8), with no significant excesses in subsequent years of follow-up. These findings confirm that PM/DM may occur as a paraneoplastic syndrome that calls for steps aimed at early cancer detection and treatment. Among long-term survivors of PM/DM, however, there is little evidence to warrant extensive preventive and screening measures beyond those recommended for the general population.Drs Chow, McLaughlin, and Fraumeni, and Ms Gridley are with the Epidemiology and Biostatistics Program, Division of Cancer Etiology, National Cancer Institute, Bethesda, MD, USA. Dr McLaughlin is currently with the International Epidemiology Institute, Rockville, MD. Ms Mellemkjær and Dr Olsen are with the Division for Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. Address correspondence to Dr Chow, National Cancer Institute 6130 Executive Blvd, EPN/415, Rockville, MD 20852, USA.     

Case-control study of squamous cell cancer of the oral cavity in Denmark

A population-based case-control study was designed to examine if the risk of developing intra-oral squamous-cell carcinoma in Denmark was associated with occupation, marital status, residence, dental status, and exposure to coffee, tea, tobacco, and alcohol. Cases consisted of 161 consecutively-admitted incident patients with histologically verified, primary, intra-oral squamous-cell carcinoma treated at the Aarhus University Hospital from January 1986 to November 1990. For each case, three controls of the same gender and age were selected randomly from among nonhospitalized residents in the hospital's catchment area (some 1.4 m inhabitants). Four hundred of the selected 483 controls participated in the study. Risk was associated significantly with marital status, residence, dental status, alcohol consumption, and exposure to tobacco. When correcting for tobacco and alcohol consumption, only marital status and dental status remained significant. The association between risk and marital status was particularly prominent among divorced compared with married persons (odds ratio [OR]=2.3, 95 percent confidence interval [CI]=1.1–4.6). Persons with less than five teeth had an OR of 2.4 (CI 1.3–4.1) compared with persons with 15 or more teeth. Tobacco and alcohol exposure were the strongest individual risk-indicators in both lifetime and current consumption estimates, and their composite effect was particularly strong. Compared with nonusers, OR for tobacco (> 20 g/d) adjusted for alcohol =5.8 (CI=3.1–10.9); OR for alcohol (> 5 drinks/d) adjusted for tobacco = 8.4 (CI=4.0–17.6). The OR for heavy users of tobacco and alcohol (> 20 g tobacco/d and > 5 drinks/d) was 80.7 (CI=21.8–298.8). These results confirm that tobacco and alcohol contribute significantly to the risk of developing oral cancer. There were no significant differences between the risk estimates for the two genders or young and old persons. Two simulation studies indicate that the observed risk associated with tobacco and alcohol consumption cannot be explained reasonably by a high consumption among the 83 nonrespondents.Drs Bundgaard, Wildt, and Elbrend are with the Department of Otorhinolaryngology, Aarbus University Hospital, Denmark, Dr Frydenberg is with the Department of Biostatistics, Aarbus University, Denmark. Dr Nielsen is with the department of Danish Cancer Society, Experimental Clinical Oncology, Aarhus, Denmark. Adress correspondence to Dr Troels Bundgaard, Department of Otorhinolaryngology, Aarhus University Hospital, 8000 Aarhus C, Denmark. This research was supported by The Danish Cancer Society, Ms K Rasmussens Foundation, and Gustav Valentin and Borghild Alice Wildes Foundation.     

Birth order and risk of testicular cancer

To explore the etiology of testicular cancer, cases of testicular cancer were identified among members of a cobort of Danish boys born between 1941 and 1957 (inclusive), who had attended schools in Copenhagen and Gentofte and whose school health records were contained in an archive under the supervision of the Danish Cancer Registry. One hundred and eighty-three cases of testicular cancer diagnosed before 31 December 1984 were identified; 366 controls, matched to cases by sex and age, were selected from the same cohort. Information on potential risk factors and confounders was obtained from two sources: school health records and midwife protocols, both of which were recorded prior to the diagnosis of testicular cancer in cases. Relative risks (RR) approximated by the odds ratios were calculated and, in logistic regression analyses, adjustments were done for known or suspected confounders. A decreasing risk of testicular cancer with increasing birth order was observed (P=0.020). Compared with being firstborn, being number four or more in birth order was associated with a significantly decreased RR for all testicular cancers (RR=0.3,95 percent confidence interval [CI]=0.3–0.8) and testicular seminoma (RR=0.1, CI=0.02–0.9). No association was observed between high social class and the risk of testicular cancer (RR=1.4, CI=0.8–2.3); neither was age at which the study subjects had mumps or measles related to risk of testicular cancer. No cases of mumps orchitis were observed before or during school years. A slightly increased RR for testicular cancer among boys from small families could be explained by the association between family size and birth order. The observed association between rank in birth order and the risk of testicular cancer was attributed to the reported differences in maternal estrogen levels in first cf second pregnancy, and supports the hypothesis of a tumor-initializing effect of high levels of estrogen early in a pregnancy on the developing testicular tissues.Dr Jensen, formerly Director of the Danish Cancer Registry and member of the CCC Editorial Board, died last year.     

Temporal Trends in Clinical and Pathological Characteristics for Men Undergoing Radical Prostatectomy Between 1995 and 2013 at Rigshospitalet,Copenhagen, Denmark,and Stanford University Hospital,United States

Purpose

To analyze how prostate-specific antigen (PSA) screening and practice patterns has affected trends in tumor characteristics in men undergoing radical prostatectomy (RP) in the United States and Denmark. Unlike in the United States, PSA screening has not been recommended in Denmark.

Human papillomavirus, herpes simplex virus and other potential risk factors for cervical cancer in a high-risk area (Greenland) and a low-risk area (Denmark)--a second look.

The prevalence of human papillomavirus (HPV) infection and other risk factors were studied in a high risk area for cervical cancer (Greenland) and in a low risk area (Denmark). From Nuuk (Greenland) and Nykøbing Falster (Denmark), random samples of 150 women aged 20-39 years were drawn. A total of 129 and 126 women were included in Greenland and Denmark, respectively. The proportion of HPV infected women assessed by ViraPap was similar in Denmark and Greenland (4.8 vs 3.9%). When type specific polymerase chain reaction (PCR) was used, the total HPV detection rate was 38.9% in the Danish population and 43.4% in the Greenlandic. A similar interrelationship between Greenland and Denmark applied to the HPV types 11, 16, 18 and 33. No relationship was observed between HPV detection and number of partners for any of the diagnostic methods. Significantly more Greenlandic than Danish women had antibodies to HSV 2, 76.0% and 26.2%, respectively. The prevalence of self-reported histories of selected venereal diseases was also highest among Greenlanders, except for genital warts where the prevalence was similar in the two areas. Greenlandic women had significantly more sexual partners, earlier age at first intercourse, more current smokers and less use of barrier contraceptives compared to the Danish women. This study confirms the results of our previous population-based cross-sectional comparison study in these areas, corroborating the conclusion that the prevalence of detectable HPV infection does not seem to be a determinant of cervical cancer incidence. However, by using DNA hybridisation techniques, temporal virus shedding is only measured at one point in time. Detectable virus shedding may not correlate with the risk of cervical cancer. In fact, HPV DNA detection may have different implications in different populations. In Denmark, HPV DNA detection may reflect transient, recently acquired infection, whereas in Greenland, it is more indicative of chronic persistent infection.     

Diet and the risk of in situ cervical cancer among white women in the United States

A case-control study of women with incident in situ and invasive cervical cancer was conducted during 1982–83 in five US areas reporting to the Comprehensive Cancer Patient Data System: Birmingham, AL; Chicago, IL; Denver, CO; Miami, FL; and Philadelphia, PA. Controls were selected by random-digit dialing and matched to invasive cases on age, race, and telephone exchange. Of the white non-Hispanic in situ cases and controls identified, 229 (78 percent) and 502 (74 percent) were successfully interviewed. Diet was assessed by asking about the usual adult frequency of consumption of 75 food items and the use of vitamin supplements. Included were the major sources of the four micronutrients postulated to reduce the risk of cervical cancer: carotenoids, vitamin A, vitamin C, and folate. Weak inverse associations between risk of in situ disease and intake of carotenoids, vitamin C, folate, fruit, and vegetables/fruits were noted but, with further analysis, these seemed attributable to residual confounding by the multiple lifestyle-related risk factors for this disease and possibly to selection bias. Vitamin A and vegetable intake were unrelated to risk. Dark yellow-orange vegetable consumption and duration of multivitamin use were cach strongly related to reduced risk of in situ disease (P for trend = 0.02 and 0.002, respectively) and need to be evaluated in other studies. The absence of persuasive protective effects for the four micronutrients and the similar findings from our analysis of invasive cervical cancer do not concur with other epidemiologic studies and suggest that the role of diet and nutrition in the etiology of cervical cancer is not yet resolved.