Racial and Geographic Differences in Mammography Screening in St. Louis City: A Multilevel Study

To examine racial differences in mammography use and its determinants in the City of St. Louis, MO, USA, we recruited women age 40 or older using random-digit dialing to (1) examine the difference in mammography use between white women and African American women and (2) identify individual- and census-tract-level risk factors of nonadherence to mammography. During telephone interviews, we inquired about mammography use and several demographic, psychosocial, and health behavior variables. We determined the residential census tracts of study subjects using a geographic information system. The rate of mammography use was 68.0% among white women and 74.7% among African American women (P = 0.022). African American women were more likely to have mammograms than white woman (adjusted odds ratio [OR] = 1.71; 95% confidence interval [CI] = 1.09-2.69). System-level barriers to mammography and heavy smoking were associated with lower mammography use among both white and African American women. Personal-experience barriers to mammography and no physician recommendation also were independently associated with mammography use among white women. White women residing within a historic geographic cluster area of late-stage breast cancer were less likely to have mammograms (adjusted OR = 0.42, 95% CI = 0.22-0.80), while African American women residing within a historic geographic cluster area of late-stage breast cancer were equally likely to have mammograms (adjusted OR = 0.79, 95% CI = 0.28-2.24). Neither individual- nor census-tract-level socioeconomic status was associated with mammography screening. These findings suggest that there may be a greater need for increasing mammography use among white women, especially in the historic cluster area of late-stage breast cancer in St. Louis.     

Occupation and breast cancer risk among Shanghai women in a population-based cohort study

INTRODUCTION: A total of 74,942 female subjects were recruited in a population-based cohort study in Shanghai, China between 1997 and 2000. We examined the relationship between occupation and breast cancer risk. METHODS: Cases were 586 women previously diagnosed with breast cancer at baseline and 438 women newly diagnosed with breast cancer during follow-up through December 2004. Eight controls were randomly selected for each case from cancer-free cohort members and frequency-matched to the cases by year of birth and age at diagnosis. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of breast cancer risk associated with occupations, adjusting for established breast cancer risk factors. RESULTS: In the prevalent breast cancer data analysis, increased risks of breast cancer were associated with technicians in engineering/agriculture/forestry (OR = 1.6, CI: 1.0-2.4), teaching personnel (OR = 1.5, CI:1.1-2.0), tailoring/sewing workers (OR = 1.6, CI:1.0-2.7), and examiners/measurers/testers (OR = 1.5, CI:1.1-2.1) among those who started the jobs at least 20 years ago. Among incident breast cancer cases, significantly increased risks were associated with medical/health care workers (OR = 1.4, CI:1.0-2.0), administrative clerical workers (OR = 1.5, CI:1.0-2.4), postal/telecommunication workers (OR = 2.2, CI:1.0-5.5), and odd-job workers (OR = 1.7, CI:1.1-2.8) among those who started the jobs at least 20 years ago. The excess risks were found in both prevalent and incident cases for postal/telecommunication workers and purchasing/marketing personnel, although ORs reached only marginal significance. CONCLUSIONS: This study suggests that white-collar professionals and several production occupations may be associated with an increased risk of breast cancer.     

The effects of physician supply on the early detection of colorectal cancer

BACKGROUND: Policymakers question whether there is a relationship between the number and distribution of physicians and the outcomes for important health conditions. We hypothesized that increasing primary care physician supply would be related to earlier detection of colorectal cancer. METHODS: We identified incident cases of colorectal cancer occurring in Florida in 1994 (n = 8,933) from the state cancer registry. We then obtained measures of physician supply from the 1994 American Medical Association Physician Masterfile and examined the effects of physician supply (at the levels of county and ZIP code clusters) on the odds of late-stage diagnosis using multiple logistic regression. RESULTS: For each 10-percentile increase in primary care physician supply at the county level, the odds of late-stage diagnosis decreased by 5% (adjusted odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.92 - 0.99; P = .007). For each 10-percentile increase in specialty physician supply, the odds of late-stage diagnosis increased by 5% (adjusted OR = 1.05; 95% CI, 1.02-1.09; P = .006). Within ZIP code clusters, each 10-percentile increase in the supply of general internists was associated with a 3% decrease in the odds of late-stage diagnosis (OR = 0.97; 95% CI, 0.95 - 0.99; P = .006), and among women, each 10-percentile increase in the supply of obstetrician/gynecologists was associated with a 5% increase in the odds of late-stage diagnosis (OR = 1.05; 95% CI, 1.01 - 1.08; P = .005). CONCLUSIONS: If the relationships observed were causal, then as many as 874 of the 5463 (16%) late-stage colorectal cancer diagnoses are attributable to the physician specialty supply found in Florida. These findings suggest that an appropriate balance of primary care and specialty physicians may be important in achieving optimal health outcomes.     

Anthropometric variables in relation to risk of breast cancer in middle-aged women

BACKGROUND: Many epidemiological studies have assessed the relationships between anthropometric variables and breast cancer risk. However, methodological approaches for analysing these factors differ appreciably. Also, age when maximum height is achieved has been identified as a potential risk factor for breast cancer in premenopausal women, but this issue has not been studied in postmenopausal women. METHODS: The participants in this population-based case-control study were postmenopausal women 50-64 years of age from the general female population of western Washington State. It included 479 women with incident primary breast cancer and 435 controls. RESULTS: This study found that: (i) women who gained over 70 pounds since age 18 had an increased risk of breast cancer relative to those who stayed within 10 pounds of their weight at age 18 (odds ratio [OR] = 2.7; 95% CI: 1.5-4.9), (ii) women with body mass indices (BMI) below what is considered healthy had a decreased risk (OR = 0.4; 95% CI: 0.2-1.1) while women with a BMI in the obese range had an increased risk of breast cancer (OR = 1.4; 95% CI: 1.0-2.1), and (iii) women who reached their maximum height at or after the age of 18 had a decreased risk of breast cancer compared to women who reached their maximum height at age 13 or younger (OR = 0.7; 95% CI: 0.5-1.0). CONCLUSIONS: By examining various anthropometric variables using clinically relevant strata, a clearer picture of how these variables relate to postmenopausal breast cancer risk was developed. Similar to younger women, postmenopausal women who reached their maximum height at later ages had a decreased risk of breast cancer.     

Clinical and demographic predictors of late-stage cervical cancer

BACKGROUND: Despite increasingly widespread use of the Papanicolaou smear, almost half of all women with invasive cervical cancer are diagnosed at a late stage (regional or distant). Little is known about factors associated with late-stage diagnosis of cervical cancer. OBJECTIVE: To examine the relationship of age, race, education level, income level, smoking, marital status, health insurance type, comorbidity, and residence in an urban or rural setting to late stage at diagnosis of cervical cancer. METHODS: Incident cases of invasive cervical cancer occurring in 1994 in Florida were identified from the state tumor registry (N = 852). Cases were linked with state discharge abstracts and the 1990 US census. Multiple logistic regression was used to determine the relationship between predictor variables (age, race or ethnicity, marital status, smoking status, education level, income level, insurance type, comorbidity, and urban vs rural residence) and the odds of late-stage diagnosis. RESULTS: Age, marital status, and insurance type were associated with late-stage diagnosis. Each additional year of age was associated with a 3% increased odds of late-stage diagnosis (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05; P<.001). Being unmarried was associated with a 63% increased odds of late-stage diagnosis (OR, 1.63; 95% CI, 1.18-2.25; P=.003). Being uninsured was associated with a 60% increased odds of late-stage diagnosis (OR, 1.60; 95% CI, 1.07-2.38; P=.02). Having commercial health maintenance organization insurance was associated with a 46% decreased odds of late-stage disease (OR, 0.54; 95% CI, 0.30-0.96; P=.04). Race, education level, income level, smoking status, comorbidity, and urban residence were not associated with stage at diagnosis. CONCLUSIONS: Women with cervical cancer who are elderly, unmarried, and uninsured are more likely to be diagnosed at a late stage. These women should be targeted for cervical cancer education and screening programs.     

Body conformation, diet, and risk of breast cancer in pet dogs: a case-control study

Canine and human breast cancer share several important clinical and histologic features. A case-control study of nutritional factors and canine breast cancer was conducted at the Veterinary Hospital of the University of Pennsylvania in 1984-1987 by interviewing owners of 150 pet dogs diagnosed with breast cancer, owners of 147 cancer control dogs, and owners of 131 noncancer control dogs. The risk of breast cancer was significantly reduced in dogs spayed at or before 2.5 years of age. Neither a high-fat diet nor obesity 1 year before diagnosis increased the risk of breast cancer according to multiple logistic regression analysis. However, the risk of breast cancer among spayed dogs was significantly reduced in dogs that had been thin at 9-12 months of age (odds ratio (OR) = 0.04 (95% confidence interval (CI) 0.004-0.4) and OR = 0.04 (95% CI 0.004-0.5) for cases vs. cancer controls and cases vs. noncancer controls, respectively, after adjustment for age at spay). Among intact dogs, the risk associated with being thin at 9-12 months of age was reduced, but not significantly so (OR = 0.60 (95% CI 0.2-1.9) and OR = 0.51 (95% CI 0.2-1.4) for the two comparisons, respectively). Results of this study suggest that nutritional factors operating early in life may be of etiologic importance in canine breast cancer.     

Raw and cooked vegetables, fruits, selected micronutrients, and breast cancer risk: a case-control study in Germany

In 1998-2000, a case-control study of breast cancer was conducted in Heidelberg, Germany. Three hundred ten consecutively recruited cases with primary breast cancer were matched according to 10-yr age groups to 353 controls with conditions unrelated to diet or endocrine disorders. Intake of raw vegetables, total vegetables, and whole-grain products was inversely associated with breast cancer risk (highest vs. lowest quartile adjusted odds ratio [OR] 0.51, 95% confidence interval [CI] 0.31-0.84; OR = 0.62, 95% CI = 0.38-1.02; and OR = 0.57; 95% CI = 0.34-0.95, respectively). Also, high intake of some selected vitamins and minerals possessing putative DNA-stabilizing properties displayed significant inverse risk associations. Adjusted ORs were as follows: vitamin C (OR = 0.49, 95% CI = 0.2-0.88), folate equivalents (OR = 0.47, 95% CI = 0.25-0.88), b-carotene (OR = 0.46, 95% CI = 0.27-0.80), zinc (OR = 0.35, 95% CI = 0.15-0.78), and copper (OR = 0.51, 95% CI = 0.31-1.03). In contrast, no significant association with risk was seen for an increased intake of fruits, cooked vegetables, fiber, calcium, manganese, or iron. In this population of German women, components of raw vegetables and some micronutrients appear to decrease breast cancer risk.     

Fruits, vegetables, soy foods and breast cancer in pre- and postmenopausal Korean women: a case-control study

We carried out a case-control study to examine the relationship between fruits, vegetables, and soy foods intake with breast cancer risk in Korean women. Incident cases (n = 359) were identified through cancer biopsies and hospital-based controls (n = 708) were selected in the same hospitals. Subjects were asked to indicate usual dietary habits, which were assessed using a semi-quantitative food frequency questionnaire (98 items). Odds ratio (OR) and 95% confidence intervals (95% CI) were calculated by unconditional logistic regression after adjustment for additional confounding factors according to the menopausal status. High grape intake showed an inverse association of breast cancer in postmenopausal women (OR = 0.59, 95% CI = 0.35-0.95; p for trend = 0.05). High tomato intake was associated with reduced breast cancer risk in premenopausal women (OR = 0.59, 95% CI = 0.38-0.89, p for trend = 0.04). In postmenopausal women, green pepper intake showed an inverse association of breast cancer risk (OR = 0.60, 95% CI = 0.43-0.96, p for trend = 0.03). High soybean intake showed an inverse association of breast cancer in postmenopausal women (OR = 0.61, 95% CI = 0.34-0.89, p for trend = 0.02). Our study suggests that high intake of some fruits, vegetables, and soybeans may be associated with a reduced breast cancer risk.     

Occupational risk factors for sinonasal cancer: a case-control study in France.

A case-control study was conducted in France to examine occupational risk factors for sinonasal cancer; 207 cases and 409 controls were included in the study. Detailed information was collected on occupational history and other potential risk factors for nasal cancer. Results are presented for three histologic types: adenocarcinoma, squamous cell carcinoma, and others. Among males, the risk of adenocarcinoma was significantly elevated for cabinetmakers (odds-ratio = 35.4, 95% confidence interval = 18.1-69.3), carpenters and joiners (OR = 25.2, 95% CI = 14.6-43.6), and wood-working machine operators (OR = 7.4, 95% CI = 3.4-15.8), whereas the odds-ratios were less than 1 for loggers and wood preparation workers. Odds-ratios associated with cabinetmakers (OR = 11.2, 95% CI = 2.7-45.9)) and carpenters and joiners (OR = 5.8, 95% CI = 1.8-18.6) were also significantly elevated for the other-histologic-types category. Significant excesses in risk of squamous cell cancer were noted for "bakers, pastry cooks, grain millers" (OR = 3.9, 1.2-12.8), construction workers (OR = 3.7, 95% CI = 1.7-8.0), and carpenters and joiners having worked for at least 15 years in the wood manufacturing industry (OR = 8.1, 95% CI = 1.3-50.3). Among females, a significant increase in risk of squamous cell carcinoma (OR = 9.5, 95% CI = 1.7-54.1) and a moderate increase in risk of adenocarcinoma (OR = 4.0, 95% CI = 0.7-23.5) was observed for textile workers. Elevated risks of squamous cell cancer were noted for farm workers of both sexes (males: OR = 2.2, 95% CI = 1.1-4.4; females: OR = 4.9, 95% CI = 1.0-24.9).     

Infertility and breast cancer: a population-based case-control study

To investigate whether a history of infertility affects a woman's risk of developing breast cancer, the authors analyzed case-control data collected between 1980 and 1982 as part of the Cancer and Steroid Hormone Study. The 4,730 cases were women aged 20-54 years with a first diagnosis of breast cancer ascertained from eight population-based cancer registries; the 4,688 controls were women randomly selected from the general population of these same eight areas. After controlling for age, age at first birth, and parity, the odds ratio (OR) for breast cancer associated with infertility was 1.01 (95% confidence interval (CI) 0.89-1.15) among gravid women. Controlling for age, the odds ratio was 0.82 (95% CI 0.59-1.14) among nulligravid women. Women who reported that the reason for their infertility was a problem with their ovaries had a risk similar to that for women without a history of infertility (OR = 0.75, 95% CI 0.48-1.24). Women whose physicians reported that the reason for their infertility was anovulation or Stein-Leventhal syndrome also had risks similar to those for women without a history of infertility (OR = 1.26 (95% CI 0.67-2.34) and OR = 1.13 (95% CI 0.46-2.78), respectively). Menopausal status, age at menarche, history of spontaneous abortions, drinking or smoking behavior, use of exogenous hormones, or family history of breast cancer did not appreciably alter the observed odds ratios. If infertility has an effect on breast cancer that is independent of age at first birth, then the effect is small.     

Occupations and breast cancer risk among Chinese women in urban Shanghai

BACKGROUND: Although, an elevated risk of breast cancer has been suggested for a number of occupations, many earlier studies were limited by selection biases, the incomplete assessment of job histories, and the inability to control for confounding. METHODS: We examined the relationship between occupational history and breast cancer risk using data from a population-based case-control study of 1,458 cases and 1,556 age-matched controls (90% response rate) conducted in Shanghai, China. Unconditional logistic regression models were used to derive odds ratios (ORs) and 95% confidence intervals (95% CIs) of breast cancer risk associated with occupations and duration of employment adjusting for non-occupational risk factors. RESULTS: The following occupations were found to be associated with an increased risk of breast cancer: laboratory technicians (OR 9.94, 95% CI 1.20-82.37), telephone and telegraph operators (OR 4.63, 95% CI 1.85-11.59), leather and fur processors (OR 3.25, 95% CI 1.11-9.53), and glass-manufacturing workers (OR 2.08, 95% CI 1.14-3.82). A dose-response pattern for years of employment was observed for leather and fur processors (P = 0.02) and glass-manufacturing workers (P = 0.01). Stratified analyses also revealed dose-response relationships between the risk of breast cancer and years of employment as inspector and product analysts among pre-menopausal women (P = 0.02), and as farmers among post-menopausal women (P = 0.04). CONCLUSIONS: This study found that several occupations are associated with an increased risk of breast cancer among women. Studies examining various occupational exposures in these high-risk occupations are warranted to identify carcinogens that may play a role in the increased breast cancer risk.     

云南省某市锡矿工人性病与艾滋病的流行病学调查

目的 估计云南省某市矿区锡矿工人性病、艾滋病感染状况及相关知识,并分析可能的危险因素。方法 2006年3-6月在云南省某市的5个矿区开展以矿区为基础的横断面研究,共纳入1796名矿工。采用标准化问卷匿名收集研究对象的性病与艾滋病知识、性行为等信息,并采集7ml静脉血和15ml尿检测4种性病和艾滋病感染情况。结果 调查矿工中共检出12例人类免疫缺陷病毒（human immunodeficiency virus,HIV）抗体阳性者,阳性率为0．7％（12／1760）,其他性病阳性率分别为梅毒1．8％（31／1760）,2型单纯疱疹（herpes simplex virustype-2,HSV-2）9．6％（169／1760）,淋球菌0．8％（14／1773）,沙眼衣原体4．8％（85／1773）,除HIV外的其他性病总患病率为14．9％（264／1776）。HIV感染和吸毒（调整OR=17．8;95％CI：4．0—78．8）、12个月内嫖娼次数（调整OR=8．7,95％CI：1．9—39．0）、文身（调整OR=6．6;95％CI：1．8—24．0）、手术（调整OR：6．0;95％CI：1．6—22．5）、共用牙刷（调整OR=5．6;95％CI：1．0—31．3）等因素的联系有统计学意义。性病感染和民族（调整OR=2．0;95％CI：1．5—2．7）、年龄（调整OR=1．7;95％CI．1．0—2．9）、吸毒（调整OR=2．3;95％CI：1．0～5．2）、和配偶住一起（调整OR=1．4;95％CI：1．1—1．9）及嫖娼（调整OR=1．9;95％CI：1．4—2．6）等因素的联系有统计学意义。艾滋病相关知识全部回答正确率为4．1％（49／1201）,有性经历的矿工中自我报告嫖娼的比例为21．6％（339／1569）。结论 该地区矿工性病、艾滋病感染率较高,性病、艾滋病知识匮乏,不安全性行为比较普遍,安全套使用率低,自我保护意识差,存在多种性病、艾滋病的传播途径,应加强该人群教育干预工作。     

Comparative analysis of non-adherence to medication treatment for systemic arterial hypertension in urban and rural populations

OBJECTIVE:

to evaluate the indexes and the main factors associated with non-adherence to medication treatment for systemic arterial hypertension between urban and rural areas.

METHOD:

analytical study based on an epidemiological survey with a sample of 247 hypertensive residents of rural and urban areas, with application of a socio-demographic and economic questionnaire, and treatment adherence assessment. The Pearson''s Chi-square test was used and the odds ratio (OD) was calculated to analyze the factors related to non-adherence.

RESULTS:

the prevalence of non-adherence was 61.9% and it was higher in urban areas (63.4%). Factors significantly associated with non-adherence were: male gender (OR=1.95; 95% CI 1.08-3.50), age 20-59 years old (OR=2.51; 95% CI 1.44-4.39), low economic status (OR=1.95; 95% CI 1.09-3.47), alcohol consumption (OR=5.92, 95% CI 1.73-20.21), short time of hypertension diagnosis (OR=3.07; 95% CI 1.35-6.96) and not attending the health service for routine consultations (OR=2.45; 1.35-4.42).

CONCLUSION:

the socio-demographic/economic characteristics, lifestyle habits and how to relate to health services were the factors that presented association with non-adherence regardless of the place of residence.     

Risk of contralateral breast cancer: associations with factors related to initial breast cancer

A case-control study was conducted to assess the risk factors associated with the development of a contralateral primary breast cancer among women who had had a first primary breast cancer. Hospital records were reviewed for 292 women who had an incident contralateral breast cancer, diagnosed in one of eight Connecticut hospitals between July 1, 1975 and December 31, 1983, and for a comparison group of 264 surviving unilateral breast cancer patients previously diagnosed in the same hospitals. All subjects were identified through the records of the Connecticut Tumor Registry. A family history of breast cancer in any first- or second-degree relative was associated with an almost threefold increased risk of developing a contralateral cancer (adjusted odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.6-4.9). Further, this relation was modified by the time elapsed since the initial cancer diagnosis (ratio of OR = 1.9, 95% CI = 1.2-3.0 for a five-year differential in time since initial diagnosis). A delay of 10 years in first full-term pregnancy was associated with a 36% decrease in risk (adjusted OR = 0.6, 95% CI = 0.3-1.2); this estimate excluded the magnitude of increased risk usually observed in studies of initial breast cancer. A conceptual framework is presented for assessing the study findings in the context of previous studies that have examined the corresponding associations for initial primary breast cancers.     

Case-control study of PCBs,other organochlorines and breast cancer in Eastern Slovakia

This case-control study was designed to investigate association between polychlorinated biphenyls (PCBs) and risk of breast cancer in an area of high environmental exposure in the Michalovce district of eastern Slovakia. Incident breast cancer cases from the Michalovce district diagnosed between May 1997 and May 1999 were recruited through the Oncology Department of the District Hospital. A total of 15 individual PCB congeners, 2,2'-bis(4-chlorophenyl)-1,1-dichloroethylene (DDE), 2,2-bis(4-chlorophenyl)-1,1,1-trichloroethane (DDT), and hexachlorobenzene (HCB) were measured in the serum of 24 breast cancer patients and 88 population controls in 1998-1999. The median levels of total PCBs were similar in cases (2586 ng/g of lipid) and controls (2682 ng/g of lipid). Higher serum levels (highest vs. lowest tertile) of total PCBs (odds ratio (OR)=0.42, 95% CI 0.10-1.82, p-for trend=0.31), group 1 congeners (OR=0.37, 95% CI 0.10-1.43, P-for trend=0.02), group 2 congeners (OR=0.32, 95% CI 0.07-1.56, P-for trend=0.60), and group 3 congeners (OR=0.49, 95% CI 0.12-2.04, P-for trend=0.51) were inversely associated with risk of breast cancer. Higher serum levels of DDE (OR=3.04, 95% CI 0.65-14.3, P-for trend=0.10) were positively associated with risk of breast cancer, while there was no association for DDT (OR=1.19, 95% CI 0.27-5.23, P-for trend=0.68), and an inverse association for HCB (OR=0.45, 95% CI 0.06-3.19, P-for trend=0.67). While generally not statistically significant, PCB and HCB levels were inversely associated with risk of breast cancer in this highly exposed population. DDE, but not DDT, was positively associated with risk.     

Salivary gland cancer: an exploratory analysis of dietary factors

This study was an exploratory analysis of dietary and other risk factors for primary salivary gland cancer in a population-based case-control study in Ontario, Canada. Cases were men and women diagnosed between 1995 and 1996 with a first primary cancer of the salivary gland, identified through the Ontario Cancer Registry. Controls were an age-matched random sample of the population of Ontario, identified through property assessment files. Cases (n = 91) and controls (n = 1897) completed a self-administered questionnaire with information on diet, smoking, height and weight, and other lifestyle and socio-demographic factors. Multivariate logistic regression was used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Among dietary variables, high relative to low intakes of alcohol (OR: 1.26; 95% CI: 0.68-2.35), fruits (OR: 1.26; 95% CI: 0.68-2.33), sweets (OR: 1.66; 95% CI: 0.85-3.25), dairy (OR: 1.41; 95% CI: 0.77-2.58), and starchy foods (OR: 1.78; 95% CI: 0.96-3.3) were associated with non-statistically significant increased risk of salivary gland cancer; whereas vegetables and meats were linked with non-statistically significant decreased risks of the disease. Among non-diet factors, male sex, obese BMI, exposure to occupational radiation, family history of cancer, and household income were suggestive of increased disease risk. Future work with larger numbers of cases are needed to further explore these associations.     

Cigarette smoking and risk of breast carcinoma in situ

BACKGROUND: Although the associations with cigarette smoking have been explored extensively for invasive breast cancer, the relation to in situ cancer has not previously been examined in depth. METHODS: We analyzed data from a population-based case-control study of women living in Wisconsin, Massachusetts, and New Hampshire. Eligible cases of incident breast carcinoma in situ were reported to statewide registries in 1997-2001 (n = 1878); similarly aged controls (n = 8041) were randomly selected from population lists. Smoking history and other risk factor information were collected through structured telephone interviews. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated from logistic regression models adjusting for potential confounders. RESULTS: In multivariate models, the OR for breast carcinoma in situ among current smokers was 0.8, compared with never-smokers (95% CI = 0.7-1.0). Risk estimates increased towards the null with greater time since smoking cessation. Odds ratios were also less than 1.0 among women who initiated smoking in adolescence (OR = 0.8) or after a full-term birth (OR = 0.7), relative to women who never smoked. The reduced odds ratios associated with current smoking were strongest among women with annual screening mammograms (OR = 0.7; 95% CI = 0.6-0.9). Odds ratios were not less than 1.0 among current smokers without a recent screening mammogram (1.3; 0.9-2.0). CONCLUSIONS: Our findings suggest an inverse association between current smoking and risk of breast carcinoma in situ among women undergoing breast cancer screening.     

Predisposing and Enabling Factors Associated with Mammography Use Among Hispanic and Non-Hispanic White Women Living in a Rural Area

ABSTRACT:  Context: Women who do not receive regular mammograms are more likely than others to have breast cancer diagnosed at an advanced stage. Purpose: To examine predisposing and enabling factors associated with mammography use among Hispanic and non-Hispanic White women. Methods: Baseline data were used from a larger study on cancer prevention in rural Washington state. In a sample of 20 communities, 537 women formed the sample for this study. The main outcomes were ever having had a mammogram and having had a mammogram within the past 2 years. Findings: Reporting ever having had a mammogram was inversely associated with lack of health insurance (OR = 0.37, 95% CI: 0.16-0.84), ages under 50 years (OR = 0.23, 95% CI: 0.12-0.45), high cost of exams (OR = 0.48, 95% CI: 0.27-0.87), and lack of mammography knowledge (OR = 0.16, 95% CI: 0.07-0.37), while increasing education levels were positively associated (OR = 1.72, 95% CI: 1.09-2.70). Reporting mammography use within the past 2 years was inversely associated with ages under 50 years (OR = 0.49, 95% CI: 0.27-0.88) and over 70 years (OR = 0.47, 95% CI: 0.24-0.94), lack of health insurance (OR = 0.23, 95% CI: 0.10-0.50), and high cost of exams (OR = 0.55, 95% CI: 0.35-0.87). Conclusions: Continued resources and programs for cancer screening are needed to improve mammography participation among women without health insurance or low levels of education.     

Evaluation of Breast Cancer Risk in a Multigenic Model Including Low Penetrance Genes Involved in Xenobiotic and Estrogen Metabolisms

Breast cancer has become the most frequent cancer among women in Westernized countries. The majority of breast cancers are due to low penetrance genes, which can act with environmental factors, particularly nutrition. Polymorphisms in gene coding for xenobiotic and estrogen metabolic pathways could increase individual cancer susceptibility and lead to the indication of individuals at higher cancer risk. A population-based, case-control study consisting of 911 breast cancer cases and 1,000 healthy control cases was performed. The association between 11 single nucleotide polymorphisms (SNP) in 7 genes and breast cancer risk was investigated in a multigenic model. The CYP1B1-432 Leu-Val and Val-Val genotypes significantly increased risk [odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.08–1.39; OR = 1.51, 95% CI = 1.17–1.94, respectively] similarly as observed with CYP1B1-453 (Asn-Ser genotype: OR = 1.17, 95% CI = 1.00–1.37; Ser-Ser genotype: OR = 1.38, 95% CI = 1.00–1.89). We showed that catechol-O-methyltransferase (COMT) could modulate the risk conferred by CYP1B1, ESR, GSTP1, and NAT2 acetylation phenotype. Additionally, a higher risk conferred by the variant for COMT was noted only for individuals presenting a high waist-to-hip ratio (COMT Val-Met, OR = 1.60, 95% CI = 1.04–2.44; COMT Met-Met, OR = 1.57, 95% CI = 0.98–2.53), suggesting a relationship with abdominal adiposity. In conclusion, COMT constitutes a crucial element in estrogen metabolism by regulating carcinogen metabolites elimination and, consequently, is a major factor in breast cancer risk.