Sex steroid hormones and breast cancer: is there a link with oral contraceptives and hormone replacement therapy?

OBJECTIVE: To determine whether use of sex steroid hormones for contraception and hormone replacement therapy alters the risk of breast cancer, and whether the risk varies with their composition, duration of use, the period of a woman's life when the hormones are used, and after successful treatment for breast cancer. DATA SOURCES: The results of important epidemiological reports, readily available from the English literature and published since 1981, were evaluated, using reports of basic scientific work as a background to the problem. STUDY SELECTION: An attempt was made to obtain most of the relevant reports. Twenty case-control and seven cohort studies were available on the oral contraceptive pill (OCP) and eleven case-control and five cohort studies on hormone replacement therapy (HRT). DATA EXTRACTION: The relative risk estimates for breast cancer (and their 95% confidence intervals) determined by each report were tabulated according to the specific conditions of analysis, for example users under age 25, duration of use. Results by meta-analysis from previous studies were also used to determine risk. A significant positive association was present when the risk estimate exceeded 1.0 and the 95% confidence interval did not cross 1.0. DATA SYNTHESIS: Among OCP users, the vast majority of reports showed no significant risk of breast cancer--overall, longest duration of use, and use before first full-term pregnancy. However, a positive association between breast cancer and users under age 25 was found in three of eight reports. Similarly, the majority of reports showed no significant risk of breast cancer among HRT users, overall as well as in relation to duration of use and interval since first use. There was no increased risk with additional progestogen; it may be protective. An improved prognosis was found in users who developed breast cancer. On the limited data, use of hormones for postmenopausal symptoms did not appear to be harmful to women who had been successfully treated for breast cancer. CONCLUSIONS: The review revealed good evidence that use of sex steroid hormones had no significant effect on the risk of breast cancer, whether given for contraception or hormone replacement. There was some concern about increased risk with prolonged use of the OCP, especially in younger women. At present, use of these hormones is a matter of informed choice, with individual considerations of the risk-benefit ratio.     

Vancomycin-resistant enterococci and use of avoparcin in animal feed: is there a link?

Australia is unique among Western countries in allowing animal use of this vancomycin-like antibiotic.     

Watermelon colon: is there an association with alcohol?

BACKGROUND: Watermelon colon, or rectal vascular ectasia of the colon, is a very rare vascular lesion. CASE REPORT: A 56-year-old male heavy drinker was admitted to hospital with hematochezia. Colonoscopy revealed linear, watermelon-like vascular stripes throughout the entire colon. Rectal biopsies confirmed the vascular nature of these lesions, showing dilated and trombosed capillaries in the lamina propria. He had neither cirrhosis nor portal hypertension. The watermelon-like lesions regressed spontaneously following the cessation of alcohol intake. CONCLUSIONS: This observation suggests that this condition can be triggered by alcohol.     

Cholecystectomy and oesophageal pathology: Is there a link?

Symptoms persist in a significant proportion of patients following cholecystectomy, some of which may have an oesophageal aetiology. The oesophagus has not previously been studied in this patient group. In this study all patients who had undergone cholecystectomy over a four year period were invited for review and symptoms were documented. Oesophageal function was examined and compared with normal controls. Patients were subdivided into symptomatic and asymptomatic subgroups and their findings compared. Symptoms were present in 53 percent of the postcholeystectomy group. The mean (sem) DeMeester acid score was higher in the post-cholecystectomy group -20.6 (3.6) than in controls - 6.7 (0.9) (p=0.01). The incidence of oesophagitis and gastritis were also increased in this group. There was a trend towards increased reflux and oesophagits in the symptomatic compared with the asymptomatic subgroup. Other findings confined to the post-cholecystectomy group included nutcracker oesophagus in 4 and irritable bowel syndrome in 3. It is suggested that cholecystectomy may be associated with changes in oesophageal function which, in turn, may be associated with persistent symptoms.     

Coffee, tea, and plasma cholesterol: the Jerusalem Lipid Research Clinic prevalence study

The association of intake of coffee and tea, assessed by 24 hour dietary recall, with plasma cholesterol and its lipoprotein fractions was studied in a sample of 1007 men and 589 women aged 35-64 resident in Jerusalem. These cross sectional data showed a significant linear association (p less than 0.001) between consumption of coffee in men and plasma cholesterol and low density lipoprotein cholesterol concentrations. Men who drank five cups of coffee or more had plasma cholesterol concentrations about 0.5 mmol/l (20 mg/100 ml) higher than non-drinkers after controlling for age, ethnicity, body mass, education, season of year, smoking, tea drinking, and dietary intake of fat and carbohydrates. In women adjusted mean plasma cholesterol concentration was 0.34 mmol/l (13 mg/100 ml) higher in coffee drinkers grouped together (p less than 0.01). The test for a linear trend was not significant. The association in both sexes was largely with the low density lipoprotein cholesterol fraction. High density lipoprotein cholesterol concentrations were somewhat increased in women who drank coffee (p less than 0.01 for a linear trend) but not in men. Tea drinking was not associated with unadjusted plasma cholesterol concentrations in either sex. Male tea drinkers, but not female, had slightly higher adjusted plasma cholesterol concentrations than non-drinkers (0.15 mmol/l (6 mg/100 ml), p = 0.04). No dose response relation was evident. In this population, characterised by a low intake of saturated fatty acids and relatively low mean plasma cholesterol concentrations, coffee drinking may be a determinant of low density lipoprotein cholesterol concentrations.     

Demographics, aging and health care: is there a crisis?

Will the aging of Canada's population bankrupt the health care system? In this issue (see pages 1555 to 1560) Dr. Marie Demers reports that the increase in physician service costs for elderly people in Quebec from 1982 to 1992 resulted primarily from increased utilization and only secondarily from the growth of the elderly population. In this editorial the author argues that the common perception that masses of elderly people will soon swamp the system deflects attention from the crucial issue of utilization. Although a wide range of interventions for elderly people have demonstrable benefits, more research is needed to ensure that intensified services, especially for elderly people in good health, are effective and well targeted. It is not the aging of our population that threatens to precipitate a financial crisis in health care, but a failure to examine and make appropriate changes to our health care system, especially patterns of utilization.     

Is there a link between cot death and child abuse?

Forty five babies delivered in Oxford obstetric units who subsequently died unexpectedly in infancy were compared with 134 controls matched for maternal age, social class, parity, and year of birth to see whether five factors identified in an earlier study as predictive of subsequent child abuse would also predict the sudden infant death syndrome. Epidemiological findings had suggested certain similarities between the two events. In contrast with babies who were abused, four of the five factors did not distinguish between babies who died suddenly and unexpectedly and their controls, but there was a slight increase in the proportion of mothers of babies who died suddenly and unexpectedly for whom nursing staff thought that support and advice on feeding the baby were needed. Factors predictive of child abuse did not predict sudden infant death in this study.     

Asian endoscopies: is there a difference?

In 1988 2062 adults had their first oesophagogastroduodenoscopy at Leicester General Hospital, of whom 224 (10.9%) were Asian. A greater proportion of the Asian patients were less than 45 years old (46% vs 24%), which reflects the age distribution of the local population. When the findings at oesophagogastroduodenoscopy were analysed in two age groups (less than or older than 45) there were no differences between the races in the younger group. However, in the older group duodenal disease was significantly more common in the Asians (P less than 0.001) whereas gastric disease was more common in Caucasians (P less than 0.05). The incidence of cancer was much lower in the Asians.     

Why is there no progress against cervical cancer?

The author reflects on the disheartening report given by Dr. E. Jean Parboosingh and associates on Canadian screening programs for cervical cancer (see pages 1847 to 1853 of this issue). Although cancer of the cervix is one of the few preventable forms of cancer, little progress has been made toward the establishment of programs to control this disease. Barriers to progress include a lack of priority given to women's health issues, insufficient public awareness of cervical cancer, the absence of vocal lobby groups, poor understanding of the limitations of secondary prevention, uncertainty about professional jurisdiction and the financial commitment of government, a tendency for minutiae to deflect attention from essential aims and the sheer complexity of the task of prevention and control. Unless these barriers are overcome it is unlikely that there will be much progress toward the eradication of cervical cancer in Canada.     

代谢综合征与结肠癌关系的 Meta 分析

目的：通过 Meta 分析探讨代谢综合征与结肠癌的关系。方法计算机检索中国知网、万方数据库、PubMed、Ovid-sp 数据库,时限为1990年1月至2014年5月。按纳入和排除标准,进行文献筛选及资料提取。采用 STATA12.0软件进行 Meta分析。结果共纳入8篇文献(6项队列研究、2项病例对照研究)。Meta 分析结果显示,代谢综合征结肠癌发病风险明显高于对照组(OR=1.43,95%CI ：1.23~1.66,P <0.05);分层分析发现,男性人群中,代谢综合征结肠癌发病风险高于对照组(OR =1.50,95%CI ：1.22~1.84,P <0.05),然而,女性人群中,其合并效应量 OR 为1.39(95%CI ：0.98~1.96,P =0.07),差异却无统计学意义。另外,与对照组相比,代谢综合征结肠癌死亡风险并未发生变化(OR=1.22,95%CI ：0.92~1.63,P =0.17)。结论代谢综合征与结肠癌发病有一定联系,但存在性别差异。代谢综合征结肠癌死亡风险并未增加,有待更多前瞻性队列研究进一步证实。     

Polyarteritis nodosa and drug abuse: is there a connection?

Drug abuse has been controversially linked to polyarteritis nodosa. A 28-year-old man with a history of drug abuse with inhaled heroin presented with an enigmatic illness consisting of refractory fever, bilateral pleural effusions, migratory polyarthritis, and a leukaemoid reaction. An abdominal angiography confirmed the diagnosis of polyarteritis nodosa, and treatment with both prednisone and cyclophosphamide resulted in significant clinical and laboratory improvement.     

Penile cancer: is there an epidemiological role for smoking and sexual behaviour?

A retrospective study was carried out to determine whether penile cancer, like cervical cancer, was associated with smoking and sexual behaviour. Altogether 244 men with penile cancer and 232 matched controls completed a questionnaire by post or telephone. Data on marital state, socioeconomic group, occupation, history of phimosis and balanitis, sexual behaviour, and smoking were obtained. The results of statistical analyses confirmed that phimosis and balanitis were risk factors for penile cancer, but there was no epidemiological evidence for it being a sexually transmitted disease. Smoking was a risk factor with a dose-response relation and remained associated with penile cancer even after adjustment for confounding factors. Penile cancer is associated with smoking independently of phimosis; treatment of phimosis alone does not remove the risk caused by smoking.