Risk of breast cancer and gynecologic cancers in a large population of nearly 50,000 infertile Danish women

Infertility is considered to influence the risk of breast cancer and gynecologic cancers. To assess this association, the authors used data from a large cohort of 54,362 women with a diagnosis of infertility who were referred to Danish fertility clinics between 1963 and 1998. Through 2003, 1,975 cancers were identified by linkage to the Danish Cancer Registry. Cancer risk was assessed through standardized incidence ratios (SIRs) and corresponding 95% confidence intervals, using general and parity-specific cancer incidence rates in the general population of Denmark as a reference. After adjustment for parity status, significantly increased SIRs were observed for breast (SIR = 1.08, 95% confidence interval: 1.01, 1.16) and ovarian (SIR = 1.46, 95% confidence interval: 1.24, 1.71) cancer. The risk of breast cancer increased with follow-up time. Similar risk patterns were observed for the different histologic types of breast cancer and all nonmucinous types of ovarian cancer, whereas the risk of mucinous ovarian cancers seemed not to be increased. These data thus suggest higher risks of breast and ovarian cancer among infertile women. However, since these results could not distinguish the effects of underlying infertility from the effects of fertility treatment, additional studies are needed to disentangle the effects of these two factors.     

Gender, race, and obesity-related quality of life at extreme levels of obesity

OBJECTIVE: Research investigating obesity-related quality of life (QOL) has shown that at increasing levels of overweight, individuals report more impaired QOL. Further, some research has indicated that white women suffer more impairment than men and African Americans. The current study sought to expand the existing literature by investigating an extreme subsample of the obese population. It was expected that participants in the current study would report more impaired obesity-related QOL than in previous research conducted with less obese individuals. It was also hypothesized that race and gender groups would differ in obesity-related QOL and that the relationship between degree of overweight and QOL would not be consistent across race and gender groups. RESEARCH METHODS AND PROCEDURES: Impact of Weight on Quality of Life Questionnaire-Lite Version data were collected from 512 individuals seeking gastric bypass surgery (mean BMI = 53.3) RESULTS: Results confirmed the study hypotheses. In general, white women reported the most QOL impairment, despite having significantly lower BMI than other race/gender groups. Compared with previous studies, the observed relationships between BMI and QOL were somewhat attenuated. DISCUSSION: Various domains of QOL may be differentially affected by degree of obesity; these relationships are not homogeneous throughout the obese population.     

Risk factors associated with senile dementia of the Alzheimer's type

Significant cognitive impairment affects approximately 15 percent of the U.S. population over age 65. The most prevalent form of irreversible dementia is senile dementia of the Alzheimer's type (SDAT), which accounts for at least 50 percent of nursing home admissions and roughly 10 billion dollars a year in health care costs. In spite of the social, economic, and medical impact of the disease, epidemiological data are scarce concerning risk factors associated with the disease. Until recently, most of the population-based studies of senile dementia in the elderly were carried out in Northern European countries. The methodological problems that arise in performing epidemiologic studies on SDAT may in part explain the lack of sufficient data pertaining to certain risk factors. This paper provides a review of the literature and research on risk factors in dementia in the elderly and discusses directions for future research. The epidemiological issues associated with certain key studies are also discussed. Although the major studies that have attempted to look at risk factors in mental illness in the elderly are beginning to fill in some of the gaps in the understanding of the etiology and epidemiology of the disease, further epidemiologic studies on both institutionalized and community-based elderly populations are needed. These should assess a wide range of possible factors (demographic, psychological, environmental, health practice, and medical) in terms of their association with SDAT. By developing a comprehensive epidemiologic profile of SDAT, possible preventive measures and therapeutic approaches to treating the disease may be identified and hypotheses for future epidemiological and laboratory investigations developed.     

An Integrative and Socio-Cultural Perspective of Health,Wealth, and Adjustment in Widowhood

Women comprise a larger proportion of the ageing population than men, often outlive their spouses, and face a variety of challenges upon widowhood. Discrete aspects of the health impact of widowhood have been described in the literature; however, the expanse of sociocontextual issues that impact on older women's adjustment is less prominent. We undertook a literature review to synthesize recent research and interventions and identify current trends and gaps in knowledge and services. Although many health, social, cultural, and economic factors impact on recently widowed older women throughout the world, we found that few interventions targeting this population incorporate these factors.     

The prevalence of domestic violence in volunteers for abortion and contraceptive research studies

BACKGROUND: The prevalence of domestic violence (DV) in research subjects has not been evaluated. In the general population, about 25% of women report DV. We hypothesize that participants in research studies would report similar rates of abuse to women in the general population and that subjects in abortion studies would report higher rates of abuse than women in other gynecologic studies. STUDY DESIGN: We included a modified abuse assessment questionnaire as a routine section of the medical history obtained for 256 women who were enrolling in abortion, contraceptive and other gynecologic research studies. Rates of reported recent or lifetime abuse, defined as physical or sexual violence, were compared for women in each study group by chi(2) analysis and Fisher's Exact Tests. A multivariable analysis with stepwise logistic regression was used to compare study groups. RESULTS: The overall rate of ever-experience DV was 18% for the study population. Lifetime rates of DV were 17%, 15% and 30% in women enrolling in abortion, contraceptive and other gynecologic research studies, respectively (p=.17). Abuse within the last 2 months was reported by 1%, 0% and 0% of women, respectively (p=.50). After controlling for age, race, ethnicity, gravity, parity and marital status, the rates of violence did not vary between study groups. CONCLUSION: We found the rates of DV in women who volunteer for research studies are similar to those reported for women in the general population. Subjects in abortion research studies do not report DV more frequently than women in contraceptive or other gynecologic studies.     

体质指数与非吸烟女性肺癌关系的病例对照研究

研究分析体质指数与非吸烟女性肺癌的关系。方法１９９２年２月至１９９３年１２月,上海地区开展的一项大规模女性肺癌人群基础上的病例对照研究,共调查了非吸烟女性肺癌病例５０４例及人群对照６０１例。     

Estimating the population attributable risk for multiple risk factors using case-control data

A straightforward and unified approach is presented for the calculation of the population attributable risk per cent (etiologic fraction) in the general multivariate setting, with emphasis on using data from case-control studies. The summary attributable risk for multiple factors can be estimated, with or without adjustment for other (confounding) risk factors. The relation of this approach to procedures in the literature is discussed. Given values of the relative risks for various combinations of factors, all that is required is the distribution of these factors among the cases only. The required information can often be estimated solely from case-control data, and in some situations relative risk estimates from one population can be applied to calculation of attributable risk for another population. The authors emphasize the benefits to be obtained from logistic regression models, so that risks need not be estimated separately in a large number of strata, some of which may contain inadequate numbers of individuals. This approach allows incorporation of important interactions between factors, but does not require that all possible interactions be included. The approach is illustrated with data on four risk factors from a pair-matched case-control study of participants in a multicenter breast cancer screening project.     

A weight shape index for assessing risk of disease in 44,820 women

The medical literature gives ample evidence of the relationship between obesity and specific diseases such as adult-onset diabetes and hypertension. Until recently the sole focus of the relationship has been between morbidity and the degree of overweight which is usually measured as weight relative to height. Recently we have shown that the location of body fat is not only associated with morbidity but that this relationship is independent of the total amount of adipose tissue. Clinical studies have shown that adipocyte size, location and metabolism are related to fat distribution. An excess of large fat cells in the upper body explains the increase risk of diabetes in women. The location of body fat has been used to delineate three body types: gynoid (pear shape), intermediate, and android (apple shape). We used waist girth divided by hip girth for scaling body shape and found that it is associated with morbidity after adjustment for relative weight. The use of relative weight and body shape simultaneously gives a better estimate of risk of morbidity than either alone. This study of 44,820 women presents easy to read graphs, derived from the multiple logistic model, which will permit practicing physicians to estimate visually the combined risks associated with relative weight and body fat location.     

Epidemiology of urinary incontinence in women

In this paper, the current knowledge and recent literature on the epidemiology of urinary incontinence are examined. The populations discussed include community-dwelling women and institutionalized women. This review includes discussions of the prevalence of urinary incontinence with age, the prevalence of the types and severity of urinary incontinence, the variations with racial and ethnic differences, and the risk factors proposed for urinary incontinence. The theories behind the currently recognized risk factors and the recent literature supporting or refuting them are analyzed. Because of an abundance of studies, only a small fraction is represented in this paper, but we attempted to emphasize high-quality and larger population studies.     

重庆市某三甲医院中青年妇科恶性肿瘤患者身心功能状况调查

目的 了解患有妇科恶性肿瘤的中青年女性身心功能状况及相关因素。方法 通过癌症患者功能状况评价量表（FACT - G）对2015年9月 - 2017年9月于重庆市某三甲医院收诊的383例中青年妇科恶性肿瘤患者进行问卷调查。结果 调查中患者FACT - G量表得分平均（63.32±19.30）分,各维度中以生理维度、情感维度、功能维度得分较低,均值仅为（14.86±5.94）、（14.81±5.29）、（14.37±6.89）分。中青年妇科恶性肿瘤患者身心功能状况的影响因素包括年龄、是否在婚、治疗阶段、化疗疗程、是否合并其他病、是否癌转移和术式（P＜0.05）,年龄越大、在婚、化疗后、化疗疗程越短、未合并其他病、无癌转移、无手术者生命质量越高。结论 中青年妇科恶性肿瘤患者身心功能状况普遍较差,以功能损害、生理和情感问题为主,提示医务人员需整体把握影响因素,以全方位改善患者生存状态。     

Quality of life assessment in women with breast cancer: benefits, acceptability and utilization

In 2006, breast cancer was the third leading cause of death in American women; however, more women survive breast cancer than any other type of cancer. As the disease progresses, it is important to know how one's health-related quality of life (QOL) is affected for those who receive treatment, those who survive, and those who remain disease-free. The purpose of this study was to summarize the benefits, challenges, and barriers of QOL measurement for female breast cancer patients. A PubMed literature search was conducted using the terms "quality of life" and "breast cancer." The search was then refined with terms related to QOL assessment instruments. The research team reviewed over 100 of the 2,090 articles identified.     

端粒长度与癌症、衰老及膳食因素的相关性研究进展

目的 综述人群中端粒长度与癌症、衰老相关疾病和膳食因素的相关性。方法 通过“端粒长度”、“癌症”、“衰老”、“膳食因素”等中文关键词及对应的英文关键词在CNKI、pubmed等数据库中进行文献检索,筛选高质量的流行病学研究。结果 端粒长度与人群癌症发病风险及死亡风险相关,与某些癌症发病风险之间可能存在U型关联;较短的端粒与心脑血管疾病的高发病风险及多种衰老相关疾病的不良预后相关;膳食因素中单一食物组分与人群中端粒长度的关系存在争议,尚需要前瞻性研究进一步探讨。结论 端粒长度具有作为多种疾病临床治疗预后生物标志物的应用潜能;前瞻性队列随访研究有助于发现膳食因素与端粒长度之间的因果关系。     

#18 Gynecologic surgeries and risk of ovarian cancer in carriers and non-carriers of the BRCA1 and BRCA2 ashkenazi founder mutations

PURPOSE: Case-control and cohort studies have established that gynecologic surgeries reduce the risk of developing ovarian cancer. It is not clear whether these surgeries also reduce risk in BRCA1 and BRCA2 mutation carriers. We studied Jewish women with incident ovarian cancer and tested for an Ashkenazi founder mutation (185 delAG and 5382insC in BRCA1 and/or 6174delT in BRCA2) to assess risk of ovarian cancer following gynecologic surgery.METHODS: Cases were identified in a population-based case-control study between 1994 and 1999. Controls were selected from the Central Population Registry and were matched to the cases based on age (within 2 years), area of birth, and place and length of residence in Israel. Excluding subjects reporting a bilateral oophorectomy, we tested 840 cases and 751 controls for the founder mutations. There were 244 (29%) cases that tested positive for BRCA1 and BRCA2, and 13 (1.7%) controls that tested positive. We used conditional logistic regression to estimate odds ratios (ORs) for developing ovarian cancer following selected gynecologic surgeries.RESULTS: Overall, gynecologic surgeries reduced the risk of ovarian cancer by 45% compared to women never having a gynecologic surgery (odds ratio (OR) = 0.55, 95% Confidence Interval (95% CI) = 0.44–0.70) after adjusting for age, ethnicity, parity, and oral contraceptive use. The risk estimate for BRCA1 and BRCA2 mutation carriers with a gynecologic surgery compared to the controls was also protective (OR = 0.51, 95% CI = 0.32–0.81).CONCLUSION: Israeli women who are carriers or non-carriers of mutations in BRCA1 and/or BRCA2 appear to benefit from a reduced risk of ovarian cancer following a gynecologic surgery.     

Potential exposure to PCBs, DDT, and PBDEs from sport-caught fish consumption in relation to breast cancer risk in Wisconsin

In Wisconsin, consumption of Great Lakes fish is an important source of exposure to polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), polybrominated diphenyl ethers (PBDEs), and other halogenated hydrocarbons, all of which may act as potential risk factors for breast cancer. We examined the association between sport-caught fish consumption and breast cancer incidence as part of an ongoing population-based case-control study. We identified breast cancer cases 20-69 years of age who were diagnosed in 1998-2000 (n = 1,481) from the Wisconsin Cancer Reporting System. Female controls of similar age were randomly selected from population lists (n = 1,301). Information about all sport-caught (Great Lakes and other lakes) fish consumption and breast cancer risk factors was obtained through telephone interviews. After adjustment for known and suspected risk factors, the relative risk of breast cancer for women who had recently consumed sport-caught fish was similar to women who had never eaten sport-caught fish [relative risk (RR) = 1.00; 95% confidence interval (CI), 0.86-1.17]. Frequency of consumption and location of sport-caught fish were not associated with an increased risk of breast cancer. Recent consumption of Great Lakes fish was not associated with postmenopausal breast cancer (RR = 0.78; 95% CI, 0.57-1.07), whereas risk associated with premenopausal breast cancer was elevated (RR = 1.70; 95% CI, 1.16-2.50). In this study we found no overall association between recent consumption of sport-caught fish and breast cancer, although there may be an increased breast cancer risk for subgroups of women who are young and/or premenopausal.     

Trends and current issues in adult fecal incontinence (FI): Towards enhancing the quality of life for FI patients

Our goals are to review the literature on the definition and epidemiology of fecal incontinence (FI), the risk factors involved, available treatment options, and measurement of the quality of life (QOL) of patients with this condition. Articles included for review were searched following the guidelines set by Cochrane Reviewers’ Handbook. FI was defined variously depending upon the duration, type, and amount of leakage. About 17 published papers were reviewed on the prevalence of FI that ranged from 1.4% to 50%. Potential risk factors included perianal injury/surgery, and fair/poor general health. QOL assessment using various grading scales provided an objective method of evaluating patients before and after treatment. Management included medical, physiotherapy, and surgical options. Through the range of various references, a clear definition of FI should be specified, which reflects its epidemiology in the various studies. These differences in definition would significantly affect its prevalence. Many risk factors have been sited but further epidemiological studies are necessary to elucidate FI. Understanding the etiology of the disease is an important initial step to provide adequate treatment of FI. QOL assessment provides objective and subjective method in the analysis of effectiveness of therapy.     

Ovarian stimulation: is there a long-term risk for ovarian, breast and endometrial cancer?

Adverse effects have been related to infertility treatments. Infertility in general, and female infertility in particular, is a well established risk factor for cancer development, especially ovarian, breast and endometrial cancer. This article addresses the possible association between infertility and cancer development, with an emphasis on the influence of infertility treatments, through a meticulous search of the literature published thus far. While results regarding the possible association of infertility, ovulation induction medications and invasive ovarian cancer show no increased risk and are reassuring, results for increased risk for breast cancer and endometrial cancer following exposure to ovarian stimulation medications are inconclusive. Larger population studies with longer periods of follow-up and better adjustment for confounding factors are needed.     

Gynecologic pain related to occupational stress among female factory workers in Tianjin,China

Abstract

Background: Dysmenorrhea, dyspareunia, and non-cyclic pelvic pain are health concerns for factory workers in China and may be increased by occupational stress.

Objectives: To estimate the prevalence and demographic and occupational factors associated with three types of gynecologic pain among female factory workers in Tianjin.

Methods: The study included 651 female workers from three factories in Tianjin, China. Logistic regression models were estimated to determine associations between occupational stress and gynecologic pain.

Results: Occupational stress including high job strain, exhaustion, and stress related to working conditions was a risk factor for gynecologic pain. High job strain and poor job security were associated with an increased risk for dysmenorrhea. Compulsory overtime and exhaustion were associated with increased non-cyclic pelvic pain. Working overtime and exhaustion were associated with increased dyspareunia.

Conclusions: As China’s population of female factory workers grows, research on the reproductive health of this population is essential.     

Diabetes, gestational diabetes and the risk of cancer in women: epidemiologic evidence and possible biologic mechanisms

At present, more than 10% of adult American women are diagnosed with diabetes mellitus (DM). As the prevalence of the disease increases, there is greater interest in the relationship between DM and other major health issues, such as cancer - one of the leading causes of death in the western world. This paper reviews the literature on the relationship between Type 2 DM and different types of cancer among women. We discuss the possible biological mechanisms that may link diabetes and cancer, important confounders, shared risk factors and a short review of the epidemiologic literature on the association between Type 2 DM and cancer of specific organs (pancreas, liver, colorectal, bladder, endometrial, non-Hodgkin's lymphoma and breast). We also examine the association between gestational diabetes, a closely related risk factor for DM in women, and subsequent risk of cancer. Cancer survival of diabetic women is also briefly discussed. The paper concludes with an agenda for future research targeting the relationship between diabetes and cancer.     

Uterine cervical cancer risk in cigarette smokers: a meta-analytic study

We conducted a meta-analytic study to measure the risk of uterine cervical cancer in former and current smokers. A literature search from 1966 to 1988 identified 139 MEDLINE citations. Of these, five studies reported appropriate and complete data for meta-analysis. A recent study conducted by the authors was also included. The graphical and variance-based methods of meta-analysis consistently demonstrated a significantly excessive risk of cervical cancer in current smokers, but not in former smokers. The powers of the analyses involving former smokers were between 0.72 and 0.99, depending on the degree of confounding attributed to unmeasured variables. Thus, it was unlikely that sample size accounted for the null association observed in former smokers. These findings have important medical implications for women in light of the prevalence of cigarette smoking. During regular gynecologic screening examinations, health care professionals may have considerable impact by counseling women about the risk of cervical cancer in smokers. Antismoking messages should be strongly directed toward women in the lower educational and socioeconomic levels to have the greatest impact on the incidence of cervical cancer.     

Quality of Life in elderly patients with cancer

The incidence of most types of cancers is age-dependent and the progressive ageing is rapidly increasing the number of elderly people who need treatment for cancer. Elderly patients present peculiar characteristics that make the choice of the correct treatment more difficult and these patients are often undertreated. Moreover, elderly patients are largely underrepresented in cancer treatment trials, and this makes the experimental evidence on this topic even weaker. Health-related Quality of Life (QOL) has been considered as one of the hard end-points for clinical cancer research, and treatment of elderly cancer patients represents a typical situation where its assessment can be particularly useful, because the expected toxicity of treatment could be relevant in the discussion of the treatment choice. However, QOL assessment in the elderly is complicated by several unresolved methodological problems (higher frequency of illiteracy, worse compliance with the questionnaires, concomitant diseases, use of instruments not validated in the aged population). Conduct of clinical trials dedicated to elderly patients is now encouraged but there are few published studies. Advanced non-small-cell lung cancer is one of the fields with the largest amount of research on QOL in elderly patients. The ELVIS study demonstrated the efficacy of single-agent chemotherapy, both in terms of QOL and of survival. The MILES study, in which combination chemotherapy was not superior than single agents, showed that baseline QOL is a strong prognostic indicator in these patients. QOL of patients with breast cancer has been another important field in clinical research over the last decades, and interest on this topic in elderly patients is growing, from loco-regional to palliative treatment.