Postmenopausal Estrogen Use and Invasive versus in situ Breast Cancer Risk

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

Factors Modifying the Association Between Hormone-Replacement Therapy and Breast Cancer Risk

Objectives: Hormone-replacement therapy (HRT) is an established risk factor for breast cancer. HRT users are different from non-users with respect to socio-economic and other characteristics. There may be women where the HRT-related risk could be modulated by other factors.Methods: We conducted a population-based case–control study with 688 breast cancer cases and 724 controls to characterize HRT users and to estimate odds ratios (OR) and 95% confidence intervals (CI) for HRT use and potentially risk modifying factors. Results: In women aged 50 years and older, 58% of controls and 61% of cases ever used HRT. Among women in natural menopause, HRT use for 10 years and more years was associated with an increased breast cancer risk (OR 1.79, 95% CI, 1.12–2.87), but not among women in surgical menopause (OR 0.61, 95% CI, 0.09–4.17). In the subgroup of women with a positive family history of breast cancer, each year of HRT use increased the risk by 1.22 (95% CI, 1.02–1.47). Another subgroup comprised women with at least 10 diagnostic mammograms (OR 4.04, 95% CI, 1.10–14.81 for using HRT 10 or more years).Conclusions: Long-term HRT use was associated with a breast cancer risk in women with natural menopause. Our findings suggest that this risk may be increased in women with a positive family history of breast cancer and in women who received frequent diagnostic mammographic screens.     

Case-control study of lifetime physical activity and breast cancer risk

A population-based case-control study of 1,233 incident breast cancer cases and 1,237 controls was conducted in Alberta, Canada, in 1995-1997 to examine the effect of lifetime physical activity patterns on breast cancer risk. No associations between physical activity and breast cancer were found for premenopausal women. For postmenopausal women in the highest quartile (> or =161 metabolic equivalent (MET)-hours/week per year) versus the lowest quartile (<104.8 MET-hours/week per year) of lifetime total physical activity, the adjusted odds ratio was 0.70 (95% confidence interval (CI): 0.52, 0.94). When the risks associated with each type of activity were examined for postmenopausal women, household and occupational activity conferred the largest risk reductions (odds ratio (OR) = 0.57, 95% CI: 0.41, 0.79 and OR = 0.59, 95% CI: 0.44, 0.81, respectively, for highest vs. lowest quartiles of activity), while recreational activity was not associated with any risk reductions. For postmenopausal women, the authors found stronger risk reductions for those who were also nonsmokers (OR = 0.64, 95% CI: 0.46, 0.88), non-alcohol-drinkers (OR = 0.39, 95% CI: 0.11, 0.77), or nulliparous (OR = 0.22, 95% CI: 0.07, 0.70) when they compared the highest with the lowest quartile of lifetime total physical activity. This study provides evidence that lifetime total activity reduces risk of postmenopausal breast cancer.     

Commuting physical activity and risk of colon cancer in Shanghai, China

Colon cancer incidence rates have been rapidly increasing in Shanghai, China, for reasons still unclear. Low physical activity is a known risk factor for colon cancer. The authors examined the effects of physical activity, particularly commuting physical activity, and its joint effects with body mass index on colon cancer risk in a population-based, case-control study. The study included 931 incident colon cancer patients and 1,552 randomly selected controls in Shanghai between 1990 and 1993. Colon cancer risk was significantly reduced among subjects with high commuting physical activity (odds ratio (OR) = 0.52, 95% confidence interval (CI): 0.27, 0.87 for men; OR = 0.56, 95% CI: 0.21, 0.91 for women), particularly among those who had high commuting physical activity for at least 35 years (OR = 0.34, 95% CI: 0.09, 0.76 for men; OR = 0.31, 95% CI: 0.07, 0.72 for women). Commuting physical activity significantly modified the risk conferred by high body mass index, with the highest risk observed among those at the highest quintile of body mass index and the lowest activity level (OR = 6.43, 95% CI: 1.82, 8.54 for men; OR = 7.42, 95% CI: 2.84, 10.01 for women). Our results suggest that regular and frequent physical activity over a long period of time protects from colon cancer and significantly modifies the body mass index-associated risk.     

The Association Between Gestational Diabetes Mellitus and Recreational Physical Activity

We aimed to investigate the association of recreational physical activity before pregnancy with gestational diabetes mellitus (GDM). A cross-sectional study was performed using self-reported data from the Pregnancy Risk Assessment and Monitoring System. The study population included 1,052 self-reported GDM cases and 10,351 non-GDM controls. Recreational physical activity in the 3 months before pregnancy was recalled in postpartum structured interviews. Compared to women exercising less than 1 day per week, women who exercised >5 days per week in the 3 months before pregnancy had a 31% lower odds of GDM (adjusted odds ratio [aOR]: 0.69; 95% confidence interval [CI]: 0.46, 1.03). Women who exercised 1–4 days per week had a 7% lower odds of GDM (aOR: 0.93; 95%CI: 0.72, 1.19). We did not observe statistically significant associations between pre-pregnancy physical activity and GDM risk. However, the magnitude and direction of association are consistent with previous observational studies. These studies collectively suggest a role of physical activity in GDM prevention.     

Leisure time sports activity and all-cause mortality in West Germany (1984–1998)

Background Current data and available studies suggest that regular physical activity decreases overall mortality. In Germany corresponding findings are scarce. The aim of this data analysis was to clarify this issue for a German sample in men and women.Methods A total of 3,742 males and 3,445 females aged 30–69, who participated in a baseline questionnaire in 1984–1986, were followed-up to the year 1998.Results During the follow-up period, 300 women and 643 men died. The multivariate rate ratios (RR) for accumulated hours of leisure time sports activities (LTSA) per week and with an LTSA-index based on METs per week with the reference of sedentary lifestyle, showed a clearly protective impact in a dose-response relationship (p for trend <0.05). Similar trends were observed in women and men. More than 2 hours of LTSA per week produced a RR of 0.70 (95% confidence interval [CI]: 0.54–0.91) in men and 0.57 (95% CI: 0.35–0.94) in women. In the group with the highest LTSA-index, the RR was 0.61 (95% CI: 0.44–0.84) in men and 0.46 (95% CI: 0.25–0.85) in women.Conclusion LTSA is inversely associated with all-cause mortality in females and males.     

Age at first full-term pregnancy, lactation and parity and risk of breast cancer: A case-control study in Spain

A case-control study was carried out in Spain to assess associations between parity, lactation and age at first full-term pregnancy and breast cancer. From November 1989 to February 1992, 184 incident breast cancer histologically confirmed cases were interviewed and matched by age and residence to 184 hospitalized patients and 184 community controls selected by random digit dialing. Multiple logistic regression was used to assess the independent influence of each factor on the risk of breast cancer in relation to other factors included in the model. Age at first full-term pregnancy was associated with breast cancer risk with an estimated odds ratio of 3.5 (95% CI 1.41–9.83) for women with their first birth after 30 years in comparison with those whose first birth was before age 21. Breast cancer risk decreased with increasing number of full-term pregnancies, OR 0.3 (95% CI 0.16–0.78) for women who had had more than 3 full-term pregnancies in comparison with nulliparous women. Among parous women, the estimated OR for women with more than 3 children was 0.4 (95% CI 0.13–0.81) after allowance for age at first childbirth and lactation. The estimated OR was 2.6 (95% CI 1.4–4.7) for women with a positive history of breast cancer in first-degree relatives. Breast cancer was not associated with total duration of lactation. The study indicates that parity is an independent risk factor associated to breast cancer and that the women with a late age at first full-term pregnancy constitute a high-risk group.     

Mammographic breast density and risk of breast cancer: Masking bias or causality?

Masking bias is hypothesized to explain associations between breast density and breast cancer risk. Tumours in dense breasts may be concealed at the initial examination, but manifest themselves in later years, suggesting an increase in breast cancer incidence. We studied the association between breast density and breast cancer risk in 0, 1–2, 3–4 and 5–6 year periods between initial examination and diagnosis. We studied 359 cases and 922 referents, identified in a breast cancer screening programme in Nijmegen, the Netherlands. Breast density was assessed at the initial examination and classified as 'dense' (if > 25% of the breast was composed of density) or 'lucent' ( 25% density). In women examined with mid-1970s film screen mammography, we found that at time 0 the odds ratio (OR) for women with dense breasts compared to those with lucent breasts was 1.4 (95% confidence interval (CI): 0.7–6.2). After a 3–4 year period the risk was increased to 3.3 (95% CI: 1.5–7.1). Then, the risk decreased again (OR: 1.2, 95% CI: 0.6–2.7). This rise and decline in risk are in accordance with the masking hypothesis. The observation, however, that the risk at time 0 does not appear to be lower for women with dense breasts than for those with lucent breasts, seems to be inconsistent with the masking hypothesis and may be indicative of causality. The same analysis were performed in women whose initial screening examination was done with current high-quality mammography. Due to the small size of this study group no firm conclusions could be drawn, but it seems as if masking bias could still play a role with high-quality mammography.     

Physical Activity Level and Risk of Death: The Severance Cohort Study

Background

Physical activity decreases deaths from cardiovascular disease and other causes; however, it is unclear whether physical activity is associated with cancer incidence and death in Asian populations.

Methods

Data from 59 636 Koreans aged 30 to 93 years were collected using a questionnaire and medical examination at the Severance Hospital Health Promotion Center between 1994 and 2004. Study participants were followed for a mean duration of 10.3 years.

Results

In the exercising group, the multivariate Cox proportional hazards model showed a lower risk of cancer death (hazard ratio [HR] = 0.72, 95% CI = 0.62–0.85) in men but not in women. Those who exercised, as compared with those who did not, had lower risks of all-cause death (men: HR = 0.68, 95% CI = 0.60–0.76; women: HR = 0.65, 95% CI = 0.53–0.79) and noncancer death (men: 0.63, 0.53–0.75; women: 0.52, 0.39–0.69). Physical activity was inversely associated with risk of noncancer death among men and women.

Conclusions

Physical activity was associated with lower risks of cancer death and noncancer death.Key words: physical activity, cancer, death, metabolic equivalent of task     

Bladder cancer, tobacco smoking, coffee and alcohol drinking in Brescia, northern Italy

The association between tobacco smoking, the consumption of coffee and alcohol and bladder cancer was investigated in a hospital-based case-control study in Brescia, northern Italy. A total of 172 incident cases (135 men and 37 women) and 578 controls (398 men and 180 women) were enrolled. As expected, cigarette smoking was strongly associated with bladder cancer. The odds ratios (OR) for coffee drinking adjusted for age, education, residence and cigarette smoking in current drinkers were 2.6 (95% confidence interval, CI: 1.1–6.1) in men and 5.2 (95% CI: 1.0–30.4) in women. A dose-response relationship was found in men, with the highest risk in the highest category of exposure: drinkers of more than 5 cups per day had an OR of 4.5 (95% CI: 1.2–16.8). The ORs for current alcohol drinkers were 2.1 (95% CI: 1.0–4.8) in men and 3.4 (95% CI: 1.2–9.7) in women; according to grams of ethanol drunk per day (grams/day, g/d) the ORs were: 1.7 (1–20 g/d), 1.6 (21–40 g/d), 4.3 (41–60 g/d) and 4.6 (61+ g/d) in men and 3.1 (1–20 g/d) and 3.9 (21+ g/d) in women. These results suggest that regular consumption of both coffee and alcohol can be independently associated with an increased bladder cancer risk.     

Changes in Dietary Intake of Methionine,Folate/Folic Acid and Vitamin B12 and Survival in Postmenopausal Women with Breast Cancer: A Prospective Cohort Study

Background: Previous experimental studies showed that limiting methionine in the diet of animals or in cell culture media suppresses mammary cancer cell proliferation or metastasis. However, no previous study has investigated the associations of changes in methionine intake with survival among breast cancer survivors. We aimed to examine the association between changes in dietary intake of methionine, folate/folic acid, and vitamin B12 from before to after diagnosis of breast cancer, and mortality among breast cancer survivors. Methods: We included 1553 postmenopausal women from the Women’s Health Initiative who were diagnosed with invasive breast cancer and completed a food frequency questionnaire both before and after breast cancer diagnosis. Multivariable Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence (CIs) of all-cause and breast cancer mortality associated with changes in methionine intake and changes in folate/folic acid and vitamin B12 intake. Results: Relative to pre-diagnosis, 28% of women decreased methionine intake by ≥20%, 30% of women increased methionine intake by ≥20%, and 42% of women had a relatively stable methionine intake (±19.9%) following breast cancer diagnosis. During a mean 16.1 years of follow up, there were 772 deaths in total, including 195 deaths from breast cancer. Compared to women with relatively stable methionine intake, women with decreased methionine intake had lower risks of all-cause (HR 0.78, 95% CI 0.62–0.97) and breast cancer mortality (HR 0.58, 95% CI 0.37–0.91) in fully adjusted models. In contrast, increased methionine intake or changes in folate/folic acid or vitamin B12 intake were not associated with all-cause or breast cancer mortality. Conclusions: Among breast cancer survivors, decreased methionine intake after breast cancer diagnosis was associated with lower risk of all-cause and breast cancer mortality.     

The effect of regular leisure physical activity on birth outcomes

Objectives: The purpose of this study was to determine the effect of regular leisure physical activity (RLPA) on two different adverse birth outcomes: timeliness of delivery (<37 weeks, preterm; 37–42 weeks, term; and >42 weeks, postterm) and low birth weight (<1500 g, very low; 1500–2499 g, low). Methods: The present sample, consisting of 9089 women, was obtained from the 1988 National Maternal and Infant Health Survey (NMIHS) data. The NMIHS was developed to examine adverse birth outcomes by assessing various maternal characteristics such as demographic, behavioral, and health care factors not found in vital statistics data. Results: The specified adjusted models obtained by logistic regression indicate that women who failed to engage in RLPA before and during their pregnancy were more likely to give birth to a very low birth weight baby [OR = 1.75; 95% CI (1.50, 2.04)] but not to a low birth weight baby [OR = 1.15; 95% CI (0.99, 1.34)] compared with women who remained active before and during pregnancy. Moreover, previously active women who stopped physical activity during pregnancy were more likely to give birth to a low birth weight [OR = 1.28; 95% CI (1.05, 1.56)] or a very low birth weight [OR = 2.05; 95% CI (1.69, 2.48)] baby than women who remained active before and during pregnancy. There was no significant relationship between RLPA and timeliness of delivery. Similar results were found after controlling for maternal medical risk. Conclusions: RLPA during pregnancy had no deleterious effect on birth outcomes among these women. RLPA may also reduce the risk of low birth weight outcomes.     

Postmenopausal estrogen use and invasive versus in situ breast cancer risk

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

Occupational physical activity and breast cancer risk in the upper Cape Cod cancer incidence study.

BACKGROUND: In several epidemiological studies, breast cancer risk has been reduced among women who reported high levels of occupational or leisure-time physical activity. We used data from a population-based case control study to evaluate the effect of occupational physical activity on breast cancer risk. METHODS: Two hundred-thirty three incident cases of breast cancer and 670 controls or their next of kin were interviewed for information on breast cancer risk factors and a complete job history. Physical activity level of jobs were classified using a Department of Labor rating scheme. We calculated adjusted odds ratios for light and medium/heavy activity jobs compared to sedentary jobs. RESULTS: Odds ratios for women who held medium/heavy jobs for less than 10 years and more than ten years were, respectively, 0.7 (95% CI = 0.4,1.3) and 1.7 (95% CI = 0.9,3.3). CONCLUSIONS: In these data there was no evidence that holding a job of medium/heavy activity reduced breast cancer risk. The study was limited by misclassification inherent in the occupational exposure scheme and by the lack of information on leisure time physical activity. The modest risk increase for subjects holding a medium/heavy job for at least 10 years probably represents either confounding or random variation.     

Physical activity and breast cancer risk among women in the southwestern United States

Physical activity may influence breast cancer risk through multiple mechanisms and at different periods in life. In this study we evaluate breast cancer risk associated with total and vigorous physical activity at ages 15, 30, and 50 years and the referent year prior to diagnosis/selection. Participants were non-Hispanic white (NHW) (1527 cases and 1601 control subjects) and Hispanic/American Indian (HAI) (798 cases and 924 controls) women. Both total and vigorous activity reduced risk of breast cancer in a dose-response manner. Among premenopausal women, only high total metabolic equivalent of the task (MET) hours of activity during the referent year was associated with reduced breast cancer risk in NHW women (odds ratio [OR] 0.62; 95% confidence interval [CI] 0.43, 0.91). Among postmenopausal women, physical activity had the greatest influence among women not recently exposed to hormones. Among these women, high total lifetime activity reduced risk of breast cancer for both NHW (OR 0.60; 95% CI 0.36, 1.02; p trend 0.01) and HAI women (OR 0.52; 95% CI 0.23, 1.16; p trend 0.07). Additionally, high total MET hours of activity at age 30 years (OR 0.56; 95% CI 0.37, 0.85) and at age 15 years (OR 0.57; 95% CI 0.38, 0.88) reduced breast cancer risk among postmenopausal NHW women not recently exposed to hormones. Among HAI women, more recent activity performed during the referent year and at age 50 appeared to have the greatest influence on breast cancer risk. Among postmenopausal NHW women. there was a significant interaction between physical activity and hormone replacement therapy (p value, 0.01), while among postmenopausal HAI women, physical activity interacted with body mass index (p value, 0.04). These data suggest that physical activity is important in reducing risk of breast cancer in both NHW and HAI women.     

Racial Differences in the Patterns of Singleton Preterm Delivery in the 1988 National Maternal and Infant Health Survey

Objectives: To determine if the association between race and preterm delivery would persist when preterm delivery was partitioned into two etiologic pathways. Methods: We evaluated perinatal and obstetrical data from the 1988 National Maternal and Infant Health Survey and classified preterm delivery as spontaneous or medically indicated. Discrete proportional hazard models were fit to assess the risk of preterm delivery for Black women compared with White women adjusting for potential demographic and behavioral confounding variables. Results: Preterm delivery occurred among 17.4% of Black births and 6.7% of White births with a Black versus White unadjusted hazard ratio (HR) of 2.8 (95% CI = 2.4–3.3). The adjusted HR for a medically indicated preterm delivery showed no racial difference in risk (HR = 1.0, 95% CI = 0.4–2.6). However, for spontaneous preterm delivery between 20 and 28 weeks gestation, the Black versus White adjusted hazard ratio (HR) was 4.9 (95% CI = 3.4–7.1). Conclusions: Although we found an increased unadjusted HR for preterm delivery among Black women compared with White women, the nearly fivefold increase in adjusted HR for the extremely preterm births and the absence of a difference for medically indicated preterm delivery was unexpected. Given the differences in the risks of preterm birth between Black and White women, we recommend to continue examining risk factors for preterm delivery after separating spontaneous from medically indicated preterm birth and subdividing preterm delivery by gestational age to shed light on the reasons for the racial disparity.     

Comorbidity of hospital-treated psychiatric and physical disorders with special reference to schizophrenia: a 28 year follow-up of the 1966 Northern Finland general population birth cohort

We studied the comorbidity of psychiatric and physical disorders in a sample (n = 11017) from the unselected, general population, Northern Finland 1966 Birth Cohort. During the period 1982–1994, hospital-treated psychiatric patients were more likely than people without psychiatric diagnoses to have been treated for physical disease in hospital wards, 298 out of 387 (77.0%) vs 6687 out of 10 630 (62.9%) (OR = 2.0, 95% CI = 1.6−2.5). Injuries, poisonings and indefinite symptoms were a more common reason for hospital treatment in people with schizophrenia or other psychiatric disorder as compared with people without a psychiatric disorder. Men with psychiatric disorder had more than a 50-fold risk for poisoning by psychotropic drugs (OR = 52.6, 95% CI = 27.7−99.8), women with psychiatric disorder a 20-fold risk (OR = 19.0, 95% CI = 9.5–38.1) and schizophrenics more than a 30-fold risk (OR = 37.5, 95% CI = 19.1–73.8). Men with psychiatric disorders were more commonly hospitalised for a variety of gastrointestinal disorders and circulatory diseases (OR = 2.3, 95% CI = 1.2–4.4), as compared with men with no psychiatric disorder. Respiratory diseases (OR = 2.2, 95% CI = 1.2–4.2), vertebral column disorders (OR = 4.2, 95% CI = 1.8–9.9), gynaecological disorders (OR = 2.1, 95% CI = 1.2–3.6) and induced abortions (OR = 1.8, 95% CI = 1.2–2.7) were more prevalent in women with psychiatric disorder than in other women. Epilepsy was strongly associated with schizophrenia (OR = 11.1, 95% CI = 4.0–31.6). Nervous and sensory organ diseases in general (OR = 2.5, 95% CI = 1.1–5.8) and inflammatory diseases of the bowel (OR = 12.8, 95% CI = 3.8–42.7) were also overrepresented in schizophrenia when compared with people without a psychiatric disorder. Our results indicate that physicians must be alert for psychiatric disorder, and mental health professionals must be aware of the considerable physical morbidity in their patients.     

Alcoholic calories, red wine consumption and breast cancer among premenopausal women

The role of alcohol consumption (alcoholic calories, alcoholic beverages) on breast cancer risk was investigated in a case-control study of 154 premenopausal female patients diagnosed with primary breast carcinoma. For each case, one control was matched for age (± 3 years) and socio-economic status. The survey was carried out in Northeastern France (Lorraine) between 1986 and 1989. While taking into account total caloric intakes and various breast cancer factors, breast cancer risk was shown to increase as consumption of alcohol increased (p value for trend = 0.007). A significant relative risk (RR = 2.69; 95% CI: 1.40–5.17) was shown above 60 kcal per day (approximately 9 g of alcohol per day). Breast cancer risk appeared to be restricted to red wine consumption among these premenopausal women, for monthly consumption (p value for trend = 0.003) as well as for duration of consumption (p value for trend = 0.01). A relative risk of 3.96 (95% CI: 1.59–9.84) was found for a monthly consumption higher than 4 liters per month. This reinforces the notion of a particular sensitivity of young women to breast cancer in relation to alcohol consumption.     

Interest in BRCA1/2 Testing in a Primary Care Population

Background. Mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 are found in less than 1/1,000 women in the general population. Experts and professional organizations recommend targeting testing to women with risk factors for carrying a mutation. Over the next decade, BRCA1/2 testing is likely to become substantially less expensive and to move into primary care practice where pretest counseling may be limited.Methods. The objective of the study was to investigate the factors associated with interest in BRCA1/2 testing among primary care patients receiving only limited information about testing. The design was a cross-sectional mailed survey. The setting was a University-based health system in the metropolitan Philadelphia region. The participants were 400 adult women cared for in a faculty General Internal Medicine practice.Results. Two hundred forty-two women (71%) completed surveys; 53% of respondents were aware of BRCA1/2 testing and 58% were interested in undergoing testing if it was both convenient and affordable. Thirty-one percent were both aware of and interested in testing. Awareness of testing was inversely associated with African–American race (OR 0.56, 95% CI 0.38–0.83) and positively associated with college education (OR 2.21, 95% CI 1.23–3.94). Interest in testing was inversely associated with a family history of breast cancer (OR 0.45, 95% CI 0.23–0.92) and increasing age (OR 0.97, 95% CI 0.95–0.99). The inverse association between family history and interest in testing persisted in the subgroup of women who were aware of testing (OR 0.55, 95% CI 0.30–0.98).Conclusions. Among a primary care population, African–American women are less aware of BRCA1/2 testing and, when provided only limited information about BRCA1/2 testing, women at lowest risk of carrying a mutation are most interested in undergoing BRCA1/2 testing. Challenges of moving BRCA1/2 testing into primary care practice include both limiting indiscriminate use by the “worried well” and, as proven cancer prevention strategies become available, ensuring access to all high-risk women regardless of race.     

The ischemic electrocardiogram: A harbinger for ischemic heart disease independent of the blood pressure level. The Copenhagen City Heart Study

Information is limited on the co-existence and prognostic association of the ischemic electrocardiogram (ECG) and blood pressure. Prospectively collected data sets from 28,118 examinations in the Copenhagen City Heart Study were analyzed for cardiac morbidity and mortality for a 5.9-year follow-up. The prognosis of the ECG, independently of blood pressure, was examined. The Cox proportional hazard model was employed to evaluate the prognostic implications of ECG findings and relative risk was adjusted for age and multivariately adjusted for traditional cardiovascular risk factors. End-points were (1) fatal and non-fatal ischemic heart disease (IHD) events and (2) cardiovascular disease (CVD) mortality. During a total follow-up period of 166,471 person years (mean: 5.9 years) 1.481 IHD events were recorded and 1.051 CVD deaths. The relative risk of an ischemic ECG was independent of the blood pressure level. The multivariately adjusted relative risk for fatal and non-fatal IHD for the ischemic ECG was 1.70 (95 CI: 1.39–2.09, p < 0.001) in women, and 1.96 (95 CI: 1.67–2.30, p < 0.001) in men, and for CVD mortality 1.71 (95 CI: 1.34–2.17, p < 0.001) in women and 2.08 (95 CI: 1.74–2.49, p < 0.001) in men. An ECG with left ventricular hypertrophy (LVH) and ST-depression was the finding with the highest risk for future events. LVH by ECG voltage-only was associated with no statistically increased risk, except for men treated for arterial hypertension.