A prospective study of cigarette tar yield and lung cancer

We examined the relationship of cigarette tar yield and other cigarette-usage characteristics in current smokers to the incidence of lung cancer in a study population of 79,946 Kaiser Permanente Medical Care Program members, aged 30–89 years, who completed a detailed, self-administered, smoking-habit questionnaire during the years 1979 through 1985. Mean length of follow-up was 5.6 years. There were 302 incident lung cancers, of which 89 percent occurred in current or former smokers. The tar yield of the current cigarette brand was unassociated with lung cancer incidence (relative risk [RR]=1.02 per 1 mg tar-yield in men, 95 percent confidence interval [CI]=0.98–1.05; RR=0.99, CI=0.96–1.03 in women). However, in long-term (>20 years) smokers, the risk of lung cancer was decreased in women who had smoked filtered cigarettes for 20 or more years relative to lifelong smokers of unfiltered cigarettes (RR=0.36, CI=0.18–0.75), but not in men who had smoked filtered cigarettes for 20 or more years (RR=1.04, CI=0.58–1.87).Authors are with the Division of Research, Kaiser Permanente Medical Care Program, 3451 Piedmont Avenue, Oakland, CA 94611, USA. Address correspondence to Dr Sidney. This study was funded by grants R01 CA 36074 and R35 CA 49761 from the US National Cancer Institute.     

Multiple myeloma among blacks and Whites in the United States: the role of chronic antigenic stimulation

Multiple myeloma (MM) is twice as common among Blacks than Whites in the United States. The reasons for this racial disparity are unknown, and the etiology of this cancer in general, is poorly understood. Repeated or chronic antigenic stimulation (CAS) of the immune system has been suggested as a risk factor. Previous case-control studies have reported inconsistent CAS associations based on evaluations of individual and biologic categories of medical conditions. Interview data from 573 cases and 2,131 population-based controls were used to investigate further the CAS hypothesis using an immunologically based approach, and to determine whether CAS accounts for the excess of myeloma among Blacks. Over 50 medical conditions were grouped into biologically and immunologically related categories, and B-cell-and T-cell-mediated response groups. Except for urinary tract infections among Black men (odds ratio [OR]=2.0), no significantly increased risks of MM were observed. However, there was a suggestion of increased risk among Blacks with an increased exposure to anaphylatic conditions. Analysis by immunoglobulin type revealed significantly elevated risks of IgG myeloma with eczema (OR=2.1), the biologic category allergic conditions (OR=1.6), and the immunologic category anaphylaxis response (OR=1.6) among Whites, with Blacks having slightly lower risks. Our findings do not support a causal relationship between CAS and MM, nor do they explain the higher incidence among Blacks.This research was funded under comtracts NO1-CP-51090, NO1-CN-0522, NO1-CP-51089, NO1-CN-31022, NO1-CP-51092, NO1-CN-05227 from the US National Cancer Institute.     

Occupational risk factors for lung cancer among nonsmoking women: a case-control study in Missouri (United States)

Occupationally related risk of lung cancer among women and among nonsmokers has not been widely studied. A recently conducted population-based, case-control study in Missouri (United States) provided the opportunity to evaluate risk of lung cancer associated with several occupational factors. Incident cases (n=429) were identified through the Missouri Cancer Registry for the period 1986 through 1991, and included 294 lifetime nonsmokers and 135 ex-smokers who had stopped at least 15 years prior to diagnosis or had smoked for less than one pack-year. Controls (n=1,021) were selected through driver's license and Medicare files. Risk was elevated among women exposed to asbestos (ever: odds ratio [OR]=3.5, 95 percent confidence interval [CI]=1.2–10.0; >9 yrs: OR=4.6, CI=1.1–19.2) and pesticides (ever: OR=2.4, CI=1.1–5.6; >17.5 yrs: OR=2.4, CI=0.8–7.0). Risk also was elevated among dry cleaning workers (ever: OR=1.8, CI=1.1–3.0; >1.125 yrs: OR=2.9, CI=1.5–5.4). Occupational risks for lung cancer among women merit further study.Drs Brownson and Chang are with the Missouri Department of Health, Columbia, MO, USA. Dr Alavanja is with the Epidemiology and Biostatistics Program, National Cancer Institute, Rockville, MD, USA. Dr Chang directs the Missouri Cancer Registry with the Missouri Department of Health. Address correspondence to Dr Brownson, Division of Chronic Disease Prevention and Health Promotion, Missouri Department of Health, 201 Business Loop 70 West, Columbia, MO 65203, USA. This study was supported in part by US National Cancer Institute contracts NO1-CP7-1096-01 and NO1-CP7-1096-02.     

Renal cell carcinoma and thiazide use: a historical,case-control study (California,USA)

Renal cell carcinoma has been linked to hypertension and antihypertensive medications. We investigated the association between renal cell carcinoma and the use of thiazide in a case-control study of 167 men and 90 women. Subjects were members of the Kaiser Permanente Medical Care Program in northern California (United States) who had taken a multiphasic health check-up from 1964 through 1988 and who were evaluated for cancer until the end of 1989. Control subjects received the same check-up, were matched by gender, year of check-up, and age at check-up, and had to be in the health plan until the date on which renal cell carcinoma was diagnosed. Data on known and potential risk factors, including hypertension, body mass index (BMI), and smoking status, were collected from the record of the check-up. Thiazide use was abstracted from the medical chart, which was reviewed from the date of the first entry until the date on which the cancer was diagnosed or the equivalent date for control subjects. The mean follow-back to check-up was 11.3 years. Among women, we found a significantly elevated risk of 4.0 (95 percent confidence interval [CI] 1.5–10.8) associated with ever having used thiazide after we adjusted for smoking, BMI, hypertension, and history of kidney infection at check-up. We did not find a statistically significantly elevated risk in men. Smoking was related to renal cell carcinoma in men (odds ratio [OR] 2.5, CI=1.1–5.4) for those who smoked at least one pack per day compared with those who had never smoked, but was not related in women. We found a statistically nonsignificant relation between BMI and renal cell carcinoma. After we adjusted for thiazide use, we did not find that hypertension was a statistically significant risk factor for renal cell carcinoma. Analysis of the dosage of thiazide measured by time since first use, duration of use, number of mentions of use in the chart, and an estimate of total grams of exposure did not result in any convincing dose-response relation. These findings are consistent with a growing body of data linking antihypertensive medication with renal cell carcinoma. We are unable to conclude whether thiazide use or some other characteristic of hypertensive persons taking these medications is responsible for the association.This study was presented at the Annual Meeting of the Society for Epidemiologic Research, 16–18 June 1993, Keystone, Colorado, USA. The research was supported by US National Cancer Institute grant NCINO1-CP-95606.     

The incidence of non-Hodgkin's lymphoma and its histologic subtypes in Asian migrants to the United States and their descendants

We examined the incidence of non-Hodgkin's lymphoma (NHL) in Chinese, Japanese, and Filipino residents of the United States to obtain further clues about the etiology of the disease. The age, race, and birthplace of residents of Hawaii, San Francisco/Oakland (California), and western Washington who had received a diagnosis of NHL during the period 1973–86 were obtained from population-based cancer registries, and a special tabulation from the 1980 Census was used to estimate the number of person-years at risk for each category of resident. The incidence of NHL in each of the Asian groups examined was 35 to 85 percent that of US-born Whites. However, there was no consistent trend of increasing incidence with increasing generation of residence in any of the groups. In Asian-Americans, the risk of small cell lymphocytic and plasmacytoid lymphoma was 10 to 85 percent that of Whites, although no clear trends of risk with generation of residence in the US were observed. They also were at a reduced risk of follicular lymphoma, and in Chinese and Japanese persons, the risk was lower in first generation than in later generation migrants (Chinese: Asian-born relative risk [RR]=0.11, US-born, RR=0.84; Japanese: Asian-born, RR=0.15, US-born, RR 0.36). The risk of diffuse lymphoma was similar in Chinese-and Japanese-Americans and US-born Whites. We conclude that, with the exception of follicular lymphoma, the basis for the relatively low incidence of NHL in Asian-Americans does not lie in exposures or characteristics that differ between the migrants themselves and their descendants.Dr Herrinton is with the Division of Research, Kaiser Permanente, Oakland, CA, USA. Dr Goldoft is with the Washington State Department of Health, Seattle, WA, USA. Drs Schwartz and Weiss are with the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, and the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA. Address correspondence to Dr Herrinton, Division of Research, Kaiser Permanente, 3505 Broadway Ave., Oakland, CA 94611, USA. This work was supported by grants no. R 35 CA 39779 and R 35 CA 49761 from the US National Cancer Institute.     

Reproductive factors and risk of brain,colon, and other malignancies in Iowa (United States)

The influence of parity on the risk of cancers of the female breast and reproductive organs is well established. However, non-reproductive sites have received less attention. Mail questionnaire data gathered from incident female cases (169 brain; 332 colon; 260 rectal; 145 kidney; and 169 pancreas cancers), and 821 populationbased controls in Iowa (United States) were used to measure the effect of parity and age at first birth on risk of these malignancies. Relative to nulliparous women, ever-parous women were at significantly decreased risk of brain cancer (odds ratio [OR]=0.44, 95 percent confidence interval [CI]=0.3–0.7) and of colon cancer (OR=0.67, CI=0.5–0.97), after adjustment for age and other risk factors. The OR for the other sites did not differ significantly from 1.0. The lower risk of brain cancer among parous women was similar in younger and older age groups, in patients diagnosed with glioblastoma and astrocytoma, and among ever- and never-smokers. The findings for colon cancer are consistent with observations from other studies. In the context of limited laboratory and clinical evidence implicating hormones in brain neoplasia, these findings may suggest a role for hormonal factors in brain cancer etiology. Hormonal factors deserve more detailed future consideration as risk factors in brain cancer.Dr Cantor is with the Environmental Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA. Dr Lynch and Ms Johnson are with the Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City, IA, USA. Address correspondence to Dr Cantor, Environmental Epidemiology Branch, National Cancer Institute, Executive Plaza North, Suite 443, Bethesda, MD 20892, USA. Supported in part by United States National Cancer Institute research contracts (NCI-NO1-CP-51026 and NCI NO1-CP-85614) and by a Public Health Service Preventive Oncology Academic Award (5 KO7 CA01181-05).     

Smoking and risk of non-Hodgkin's lymphoma and multiple myeloma

Population-based case-control interview studies of 622 White men with non-Hodgkin's lymphoma and 820 controls from Iowa and Minnesota (United States) and 173 White men with multiple myeloma and 452 controls from Iowa offered the opportunity to investigate the relationship of these cancers with smoking. Risks were significantly elevated for all lymphoma (odds ratio [OR]=1.4), high-grade lymphoma (OR=2.3), and unclassified lymphoma (OR=2.8) for cigarette smokers. Dose-response gradients were not seen with intensity of cigarette use, but risks for these subtypes were greatest for cigarette smokers of longest duration. Similar elevations in risks were seen for tobacco users. The risk of multiple myeloma was not significantly elevated for either tobacco users or cigarette smokers. The findings from this study confirm the lack of an association between smoking and multiple myeloma and provide some support for an association between tobacco use and certain subtypes of non-Hodgkin's lymphoma.Ms Brown and Dr Blair are with the Epidemiology and Biostatistics Program, National Cancer Institute. Dr Everett is with the Department of Internal Medicine, Orlando Regional Medical Center, Orlando, FL, USA. Drs Gibson and Schuman are in the Department of Epidemiology, University of Minnesota, Minneapolis, MN, USA. Dr Burmeister is in the Department of Preventive Medicine, University of Iowa, Iowa City, IA, USA. Address correspondence to Ms Brown, Epidemiology and Biostatistics Program, National Cancer Institute, Executive Plaza North, Room 415C, Bethesda, MD 20892, USA. This work was supported in part by a grant from the National Institute of Environmental Health Sciences (ES 03099).     

Pesticide exposures and multiple myeloma in Iowa men

A population-based case-control study of 173 White men with multiple myeloma (MM) and 650 controls was conducted in Iowa (United States), an area with a large farming population, to evaluate the association between MM, agricultural risk factors, and exposure to individual pesticides. A slight nonsignificantly elevated risk for MM was seen among farmers (odds ratio [OR]=1.2, 95 percent confidence interval [CI]=0.8–1.7). Although slight excesses were observed, there were no significant associations between MM and handling either classes of pesticides or specific pesticides. Thus, this study found little evidence to suggest an association between risk of MM and farming or pesticides.Ms Brown and Dr Blair are with the Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD, USA. Dr Burmoistor is with the Department of Preventive Medicine, University of Iowa, Iowa City, IA, USA. Dr Everett is with the Department of Internal Medicine, Orlando Regional Medical Center, Orlando, FL, USA. Address correspondence to Ms Brown, Epidemiology and Biostatistics Program, National Cancer Institute, Executive Plaza North, Room 415, Bethesda, MD, USA. This project was supported in part by a grant from the National Institute of Environmental Health Sciences (ES 03099).     

Epidemiology of the M-component immunoglobulin types of multiple myeloma

The purpose of this population-based case-control study was to learn whether risk factors differ for the individual immunoglobulin types of multiple myeloma. In particular, we sought to determine whether IgA and IgG myeloma were related to a history of exposure to reported IgA- and IgG-stimulating conditions, respectively, or to a history of selected occupational and physicochemical exposures. The M-component immunoglobulin type was determined from immunoelectrophoresis as reported in medical records, and exposure status was obtained through in-person interviews. IgG (56 percent) and IgA (22 percent) M-components predominated. For 17 percent of cases, no peak was found on immunoelectrophoresis; they were presumed to have light-chain myeloma. Persons with these three types of myeloma did not differ with respect to distributions of age or race, but a somewhat higher proportion of light-chain cases were women (58 percent cf 45 percent of all other cases). Detailed analysis of the IgA and IgG subtypes provided little evidence that they differ with respect to prior immune stimulation or employment in several specific jobs. IgA myeloma, but not IgG myeloma, was associated modestly with a history of exposure to chest and dental X-rays. Our study provides little evidence that IgA and IgG myeloma differ with respect to the risk factors examined.Ms Herrinton and Drs Koepsell, Weiss, and Daling are with the Department of Epidemiology, University of Washington, Seattle, WA, USA, and the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Dr Demers is with the Department of Environmental Health, University of Washington, Seattle, WA, USA. Dr Taylor is with Group Health Cooperative of Puget Sound, Seattle, WA, USA. Dr Lyon is with the School of Medicine, University of Utah, Salt Lake City, UT, USA. Dr Swanson is with the Cancer Center, Michigan State University, East Lansing, MI, USA. Dr Greenberg is with the School of Public Health, Emory University, Atlanta, GA, USA. Address correspondence to Ms Lisa Herrinton, Fred Hutchinson Cancer Research Center, 1124 Columbia MP-381, Seattle, WA 98104, USA. The project was supported by grants CA23350, CA39779, and CA09168 from the US National Cancer Institute.     

Temporal trends in the incidence of cutaneous malignant melanoma among Caucasians in the San Francisco-Oakland MSA

Temporal changes in the incidence of cutaneous malignant melanoma (CMM) were examined in the San Franscisco-Oakland (California, United States) Metropolitan Statistical Area (MSA) between 1976 and 1987, using data from the population-based cancer registry. This analysis was conducted after the completion of a project designed to eliminate bias in the reporting of CMM due to changes in medical practice. The incidence of CMM is higher in the San Francisco-Oakland MSA than nationally. From 1976 through 1987, the incidence of invasive CMM increased from 9.8±0.9 to 16.5±1.1 per 100,000 (P=0.0001) among men and from 9.3±0.8 to 12.7±0.9 per 100,000 (P=0.001) among women. Age-specific, histologic-specific, and anatomic site-specific trends were also evaluated. The temporal patterns of CMM suggest that the recent increases are not accounted for solely by ascertainment bias due to reporting practices. The observed trends are consistent with early detection efforts and with changes in the prevalence of risk factors.Authors are at the Northern California Cancer Center, Alameda, CA, USA. Dr Holly is also with the Department of Health Research and Policy, Stanford University School of Medicine, and the Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, USA. Address correspondence to Dr Horn-Ross, Northern California Cancer Center, 1420 Harbor Bay Pkwy, Suite 260, Alameda, CA 94501, USA. This research was supported by contract N01-CN-05224 from the Surveillance, Epidemiology, and End Results Program, National Cancer Institute, contract N01-CP-05681 from the National Cancer Institute, and subcontract 050E-8708 from the California Tumor Registry, California State Department of Health Services.     

Vasectomy and the risk of prostate cancer in a cohort of multiphasic health-checkup examinees: second report

The relationship of vasectomy to prostate cancer was studied in 5,119 men with a self-reported history of vasectomy, identified at multiphasic health checkups undergone during 1977–82 while members of the Northern California Kaiser Permanente Medical Care Program. Three unvasectomized comparison subjects were identified for each vasectomized man, matched for age, race, marital status, and date and location of the examination. Follow-up for incident prostate cancer was conducted for a mean length of 6.8 years. The relative risk of prostate cancer associated with vasectomy was 1.0 (95% confidence interval = 0.7–1.6); the relative risk was approximately one, regardless of length of interval (less than 10 years, 10–20 years, more than 20 years) between vasectomy and multiphasic health checkup or the age at vasectomy (less than 40 years vs more than 40 years). These data support earlier findings reported in this study group of the lack of an association of vasectomy with subsequent risk of prostate cancer.Supported by a grant from Merck Sharp and Dobme Research Laboratories.     

Infertility, treatment of infertility, and the risk of breast cancer among women with BRCA1 and BRCA2 mutations: a case–control study

Background  Women with a breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2) mutation are at increased risk for developing breast and ovarian cancer. Various reproductive and hormonal factors have been shown to modify the risk of breast cancer. These studies suggest that estrogen exposure and deprivation are important in the etiology of hereditary cancer. Many patients are interested in the possibility of an adverse effect of fertility treatment on breast cancer risk. It is important to evaluate whether or not infertility per se or exposure to fertility medications increase the risk of breast cancer in genetically predisposed women. Methods  We conducted a matched case–control study of 1,380 pairs of women with a BRCA1 or BRCA2 mutation to determine if a history of infertility, the use of fertility medications, or undergoing in vitro fertilization (IVF) were associated with and increased the risk of breast cancer. Results  Sixteen percent of the study subjects reported having experienced a fertility problem and 4% had used a fertility medication. Women who had used a fertility medication were not at significantly increased risk of breast cancer (odds ratio [OR] = 1.21; 95% confidence interval [CI] = 0.81–1.82) compared to non-users. Furthermore, there was no risk associated with a history of use of a fertility medication when the subjects were stratified by parity: (OR = 1.29; 95% CI = 0.83–2.01 for nulliparous women and OR = 0.81; 95% CI = 0.30–2.22 for parous women). Conclusions  The results of this study suggest that the use of fertility medications does not adversely affect the risk of breast cancer among BRCA mutation carriers. Given the small sizes of the exposed subgroups, these findings should be interpreted with caution and confirmatory studies are required. Other Members of the Hereditary Breast Cancer Clinical Study Group: D. Horsman, British Columbia Cancer Agency, Vancouver, BC, Canada; B. Rosen, Familial Ovarian Cancer Clinic, Princess Margaret Hospital, Toronto, ON, Canada; C. Isaacs, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA; S. Domchek, Departments of Hematology and Oncology, University of Pennsylvania, USA; R. Gershoni-Baruch, Institute of Genetics, Rambam Medical Center, Haifa, Israel; A. Eisen, Cancer Risk Assessment Clinic, Juravinksi Cancer Centre (Hamilton Regional Cancer Centre), Hamilton, ON, Canada; O. I. Olopade, Center for Clinical Cancer Genetics, University of Chicago, Chicago, IL, USA; E. Friedman, The Suzanne Levy Gertner Oncogenetics Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel, and the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; H. M. Saal, Hereditary Cancer Program, Division of Human Genetics, Children’s Hospital Medical Center, Cincinnati, OH, USA; S. L. Neuhausen, Epidemiology Division, Department of Medicine, University of California, Irvine, USA; M. Daly, Division of Population Science, Fox Chase Cancer Center, Philadelphia, PA, USA; B. Karlan and R. N. Kurz, Gynecology Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA; C. Bellati, Section of Genetics, University of Turin, Turin; Italy C. Eng, Chair of Genomic Medicine Institute at the Cleveland Clinic Foundation Cleveland, Cleveland, OH, USA; K. Sweet, Clinical Cancer Genetics Program, Comprehensive Cancer Center, Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus OH, USA; T. Wagner, Department of Gynecology, Division of Senology, Medical University of Vienna and Private Trust for Breast Health, Austria; G. Rennert, National Cancer Control Center, Carmel Medical Center, Haifa, Israel; D. Provencher and C. Maugard, University of Montreal, Quebec, Canada; J. Garber, Dana Farber Cancer Center, W. McKinnon and M. Wood, University of Vermont; D. Gilchrist, University of Alberta; M. Osborne, Strang Cancer Prevention Centre, New York, NY, USA; J. McLennan, University of San Francisco, California, USA; S. Merajver, University of Michigan Comprehensive Cancer Cente;, B. Pasche and T. Fallen, Northwestern University Cancer Genetics Program, Chicago, Illinois, USA; E. Lemire, Division of Medical Genetics, Royal University Hospital and the University of Saskatchewan, Saskatoon, Canada; A. Chudley, Children’s Hospital, Winnipeg, Manitoba, Canada; J. Weitzel, Department of Cancer Genetics, City of Hope National Medical Center, Duarte, California, USA; W. S. Meschino, North York General, North York, ON, Canada; D. Rayson, Queen Elizabeth Health Sciences Centre, Halifax, Nova Scotia, Canada; G. Evans, Regional Genetics Service, St. Mary’s Hospital, Manchester, UK; D. Agnese, Division of Human Genetics, The Ohio State University; and H. Olsson, Jubileum Institute, Department of Oncology, Lund University Hospital, Lund, Sweden.     

Clinician awareness and knowledge of breast cancer-related lymphedema in a large, integrated health care delivery setting

Breast cancer survivors have reported dissatisfaction regarding their education on risk of breast cancer-related lymphedema (BCRL) from clinicians. We describe clinician knowledge and treatment referral of patients with BCRL among active oncologists, surgeons, and primary care physicians in the Kaiser Permanente Northern California Medical Care Program. A total of 887 oncologists, surgeons, and primary care clinicians completed a 10-minute web survey from May 2, 2010 to December 31, 2010 on BCRL knowledge, education, and referral patterns. A knowledge score of BCRL was calculated based on clinician responses. Multivariable regression models were used to determine the associations of selected covariates with BCRL knowledge score and clinician referral, respectively. Compared with primary care clinicians, oncologists had the highest mean score followed closely by surgeons (P < 0.0001). In multivariable analyses, being female, an oncologist or surgeon, and recently receiving BCRL materials were each significantly associated with higher BCRL knowledge scores. About 44% of clinicians (n = 381) indicated they had ever made a BCRL referral (100% oncologists, 79% surgeons, and 36% primary care clinicians). Clinicians with a higher knowledge score were more likely to make referrals. In stratified analyses by specialty, the significant associated factors remained for primary care but became non-significant for oncology and surgery. These results can inform educational interventions to strengthen clinician knowledge of the clinical management of BCRL, especially among primary care clinicians. With the growing number of breast cancer survivors, increasing clinician education about BCRL across all specialties is warranted.     

Daily aspirin use and prostate cancer risk in a large,multiracial cohort in the US

Objective: To examine the relationship between daily aspirin use and risk of prostate cancer in a large, racially diverse cohort of men followed for up to 32 years. Methods: The study population included 90,100 male subscribers to the Kaiser Permanente Medical Care Program who had received one or more multiphasic health checkups between 1964 and 1973. This general health checkup included a self-completed questionnaire that requested men to record if they took more than six aspirin almost every day during the previous year. Subjects were followed for the development of prostate cancer using the local tumor registry. Cox regression was used to estimate relative risks (RR) and 95% confidence intervals (CI). Results: A total of 2574 men developed prostate cancer. Of these, 1617 had local stage disease and 719 had either regional or distant disease at diagnosis. A total of 2466 men (2.7%) reported taking more than six aspirin almost every day during the past year at one or more health checkups. After adjusting for birth year, education, race, and the number of health checkups, the relative risk of prostate cancer associated with this amount of aspirin use was 0.76 (95% CI 0.60–0.98). Relative risks did not differ by race and were similar for both local stage and regional or distant stage prostate cancer. Conclusion: Results from our large, multiracial cohort study support a modest inverse relationship between daily consumption of more than six aspirin and prostate cancer risk.     

Retrospective cohort study of risk-factors for esophageal cancer in Linxian,People's Republic of China

A retrospective cohort study of esophageal (including gastric cardia) cancer was conducted to examine dietary and other potential risk factors in Linxian, a high-risk area in P.R. China. Study subjects were identified based on participation in a cytology examination conducted in 1974. They were interviewed in 1989 to obtain information on esophageal cancer risk-factors and identify new cases and deaths. A total of 1,162 subjects from the analytic cohort of 12,693 were determined to have developed esophageal cancer over the 15-year follow-up period. Results indicate that increased age, male gender, a positive family history, low education level, surface-water use, and pork consumption were the strongest risk factors for esophageal cancer identified in this cohort, while use of corn as a primary staple and infrequent consumption of fresh vegetables also were possible risk factors. Traditional or suspected risk factors for esophageal cancer in this and other populations—smoking and alcohol use, and pickled vegetable and moldy food consumption—were not risk factors in this study. Some variation in risk was seen based on the subject's cytology result from 1974. We conclude that dietary factors appear to play a role in the etiology of esophageal cancer in this high-risk population, but are less important than other constitutional factors such as age, gender, and family history.Drs Yu, Li, Wang, Guo, Wang, Liu, and Li are with the Cancer Institute of the Chinese Academy of Medicinal Sciences in Beijing, PRC. Drs Taylor, Dawsey, and Blot are with the National Cancer Institute in Bethesda, MD, USA. Dr Shen is with Henan Medical University in Zhengzhou, PRC. This project was funded partially by contract # NO1-CP-41019 from the US National Cancer Institute.     

Alcohol consumption,smoking, and other risk factors and prostate cancer in a large health plan cohort in California (United States)

Alcohol consumption and cigarette smoking have been suggested as possible causes of prostate cancer. We therefore examined this relation in a cohort of 43,432 men who were members of a prepaid health plan in northern California (United States) and who had received a health examination in the period from 1979 through 1985. Detailed information on demographic variables, alcohol consumption, smoking habits, medical complaints and conditions, occupation, and surgery (including vasectomy) was assessed. Symptoms of prostatism and a history of sexually transmitted diseases were abstracted from the medical records of all prostate cancer patients and of a matched subsample of randomly selected control-subjects. Alcohol consumption was associated with no elevated prostate cancer risk for the 238 men in our study in whom prostate cancer developed, but smoking one or more packs of cigarettes per day was associated with an adjusted relative risk (RR) of 1.9 (95 percent confidence interval [CI]=1.2–3.1). Prostate cancer risk for Black men was 2.2 (CI=1.6–3.1) when compared with that for White men, and education level was associated positively in an increasing trend (P<0.02) up to an RR of 1.4 (CI=0.9–2.1) among men with postgraduate education. Symptoms of prostate hypertrophy were not associated with elevated risk of prostate cancer if they occurred two or more years before the diagnosis. The finding that smoking increased the risk of prostate cancer confirms the observations of others but needs cautious interpretation because we were unable to adjust for the potential confounding effect of dietary and hormonal factors.Presented in abstract form at the 118th annual meeting of the American Public Health Association and related organizations, New York City, September 30–October 4, 1990. The research was supported by US National Cancer Institute Contract N01-CP-95606 and by the Alcoholic Beverage Medical Research Foundation, Baltimore, Maryland, USA.     

Hypertension is an independent predictor of survival disparity between African‐American and white breast cancer patients

The objective of this study was to determine whether comorbidity, or pre‐existing conditions, can account for some of the disparity in survival between African‐American and white breast cancer patients. A historical cohort study was conducted of 416 African‐American and 838 white women diagnosed with breast cancer between 1973 and 1986, and followed through 1999 in the Kaiser Permanente Northern California Medical Care Program. Information on comorbidity, tumor characteristics and breast cancer treatment was obtained from medical records, and Surveillance, Epidemiology and End Results, Northern California Cancer Center Registry. Associations between comorbidity and survival were analyzed with multiple Cox proportional hazards regression. Over a mean follow‐up of 9 years, African Americans had higher overall crude mortality than whites: 165 (39.7%) versus 279 (33.3%), respectively. When age, race, tumor characteristics and breast cancer treatment were controlled, the presence of hypertension was associated with all cause survival [hazard ratio (HR) = 1.33, 95% confidence intervals (CI) 1.07–1.67] and it accounted for 30% of racial disparity in this outcome. Hypertension‐augmented Charlson Comorbidity Index was a significant predictor of survival from all causes (HR = 1.32, 95%CI 1.18–1.49), competing causes (HR = 1.52, 95%CI 1.32–1.76) and breast cancer specific causes (HR = 1.18, 95%CI 1.03–1.35). In conclusion, hypertension has prognostic significance in relation to survival disparity between African‐American and white breast cancer patients. If our findings are replicated in contemporary cohorts, it may be necessary to include hypertension in the Charlson Comorbidity Index and other comorbidity measures. © 2008 Wiley‐Liss, Inc.     

Viral and non-viral risk factors for non-Hodgkin’s lymphoma in Egypt: heterogeneity by histological and immunological subtypes

Objective  Non-Hodgkin’s lymphomas (NHL) are etiologically heterogeneous malignancies. In Egypt, we previously reported an association of increased NHL risk with chronic hepatitis C virus (HCV) infection. Our present aim is to assess the association between HCV infection and histological subtypes of NHL. Methods  We conducted a case–control study at the National Cancer Institute of Cairo University. Cases with NHL (n = 486) were matched to controls (n = 786) who were orthopedic patients from the same referral regions. Participants provided a blood sample for HCV markers (anti-HCV, HCV RNA) and answered a questionnaire on possible risk factors. Case–control differences were assessed by odds ratios and 95% confidence intervals from logistic regression analysis. Results  Cases with diffuse large B cell lymphoma (n = 146), chronic lymphocytic leukemia (n = 58), marginal zone lymphoma (n = 24), follicular lymphoma (n = 23), and mantle cell lymphoma (n = 16) were recruited. HCV RNA prevalence was 27% in controls and 26%–48% in the NHL subgroups: it was associated (p < 0.001) with diffuse large B cell, marginal zone, and follicular lymphomas with odds ratios of 3.2, 4.4, and 3.3, respectively. Conclusion  HCV is a risk factor for diffuse large B cell, marginal zone, and follicular lymphomas in Egypt.     

Ultraviolet radiation, dietary vitamin D, and risk of non-Hodgkin lymphoma (United States)

Objective Because of conflicting findings about the relationship between ultraviolet (UV) radiation and the risk of non-Hodgkin lymphoma (NHL), we evaluated the risk of several indicators related to UV, including two not previously studied: dietary vitamin D, and ambient UV levels by residential location. Methods As part of a case–control study conducted in four Surveillance, Epidemiology, and End Results (SEER) registries, we collected UV information from a self-administered questionnaire and computer-assisted personal interview with 551 NHL cases and 462 controls. We estimated the relative risk (RR) and 95% confidence intervals (CI) from unconditional logistic regression models. Results Eye color, a marker of host susceptibility to UV, showed a decreasing risk gradient for lightest eyes (0.47) compared to darkest. Relative risks were in the range of 0.73–0.78 for participants reporting more hours in the mid-day summer sun. Use of sunlamps or tanning booths was associated with decreased risk (RR = 0.88), as was estimated overall ambient UV (RR = 0.76 per 50 RB-units) overall. Vitamin D intake from diet and supplements was not related to risk. Results were thus consistent for the various indicators, although some estimated risks were not statistically significant. Effects were generally similar for diffuse large B-cell (DLBCL) and follicular lymphomas. Conclusion These data suggest a slight protective effect of sunlight against NHL, and they agree with geographic patterns of NHL incidence observed in the US. This research was supported by the Intramural Research Program of the NIH, National Cancer Institute, and conducted with contracts: N01–PC-67010, N01-PC-67008, N02-PC-71105, N02-CP-31003, N01-PC-67009, and N01-PC-65064.     

Life After Cancer Epidemiology (LACE) Study: A cohort of early stage breast cancer survivors (United States)

The Life After Cancer Epidemiology (LACE) Study, a cohort of 2321 early stage breast cancer survivors, was established in 2000 to examine how modifiable behavioral risk factors affect quality of life and long-term survival. Women were recruited primarily from the Kaiser Permanente Northern California Cancer Registry (KPNCAL) and the Utah cancer registry (UCR), United States. Baseline data were collected, on average, at two years post-diagnosis through self-administered questionnaires that included information on demographics, medical history, anthropometry, diet, supplements, physical activity and quality of life. The purpose of this paper is to describe the creation and baseline characteristics of the cohort. Forty-six percent of women to whom questionnaires were mailed agreed to participate. The cohort which is 80% white, was diagnosed predominantly with Stage I and II breast cancer (93%), and will have been followed for 5.6 years post-diagnosis, on average, by the end of 2004. Women reported slightly over four daily servings of fruit and vegetables, well below the suggested 5-A-Day national guidelines. Compared to women free of cancer, physical activity patterns were similar, while weight gain, especially in younger women, was higher than is typical. These data suggest that in the early years post-diagnosis, breast cancer survivors exhibit similar patterns to the general population in many health behaviors.* Address correspondence to: Bette Caan, Dr. PH, Division of Research, Kaiser Permanente Medical Program, 2000 Broadway, Oakland, CA 94612, USA. Ph.: +1-510-891-3719; Fax: +1-510-891-3761; E-mail: Bjc@dor.kaiser.org