Breast cancer risk in older women: results from the NIH-AARP Diet and Health Study

Background

Divergent risk factors exist for premenopausal and postmenopausal breast cancers, but it is unclear whether differences by age exist among postmenopausal women.

Methods

We examined relationships among 190,872 postmenopausal women, ages 50–71 years recruited during 1995–1996 for the NIH-AARP Diet and Health Study, in whom 7,384 incident invasive breast carcinomas were identified through 2006. Multivariable Cox regression hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated for breast cancer risk factors by age (50–59, 60–69, ≥70 years).

Results

The only factor showing significant statistical heterogeneity by age (p _het = 0.001) was menopausal hormone therapy duration, but trends were apparent across all ages and the strongest association prevailed among women 60–69 years. Although other risk factors did not show statistically significant heterogeneity by age, we did observe attenuated relations for parity and late age at first birth among older women [e.g., HR for age at first birth ≥30 vs. 20–24 = 1.62 (95 % CI 1.23–2.14) for women 50–59 years vs. 1.12 (0.96–1.31) for ≥70 years]. In contrast, risk estimates associated with alcohol consumption and BMI tended to be slightly stronger among the oldest subjects [e.g., HR for BMI ≥35 vs. 18.5–24.9 = 1.24 (95 % CI 0.97–1.58) for 50–59 years vs. 1.46 (1.26–1.70) for ≥70 years]. These differences were somewhat more pronounced for estrogen receptor positive and ductal cancers, tumors predominating among older women. Breast cancer family history, physical activity, and previous breast biopsies did not show divergent associations by age.

Conclusion

Although breast cancer risk factor differences among older women were not large, they may merit further consideration with respect to individualized risk prediction.     

Obesity, Metabolic Factors, and Colorectal Adenomas: a Retrospective Study in a Racially Diverse New York State Hospital

Objective

We studied a racially diverse population and the relationship with colorectal adenomas (CA) further looking for risks related to BMI and metabolic factors.

Designs

Seven hundred seventy-nine patients who underwent screening colonoscopies between 2007 and 2009 meeting exclusion criteria were included. To evaluate the association between race, BMI, and other metabolic factors with having one or more CA detected at colonoscopy, adjusted odds ratios and 95 % CI were estimated using unconditional logistic regression models.

Outcomes

CA were detected in 167 out of 779 (21.4 %) patients. Compared to Whites, Hispanics were less likely to have one or more adenomas detected during a screening colonoscopy (OR?=?0.52, 95 % CI, 0.31–0.88; p?=?0.01). There was no significant statistical difference between Blacks and Whites, or other races and Whites. There was an association between the presence of CA and smoking (OR?=?1.57, 95 % CI, 1.02–2.43; p?=?0.04).

Conclusion

Our results showed that Hispanics were less likely to have an adenoma detected during a screening colonoscopy than Whites. No statistical significant difference was found between patients with metabolic factors and the presence of colorectal adenoma.     

Effect of screening mammography on cumulative survival of Japanese women aged 40–69 years with breast cancer

Background

The effectiveness of screening mammography (MMG) has mainly been demonstrated by studies in western countries. This study was conducted to evaluate cumulative survival and the risk of breast cancer death among Japanese women aged 40–69 years with screening-detected and interval breast cancer divided into three groups: MMG with clinical breast examination (CBE), CBE alone, and self-detection.

Methods

By matching a list of 126,537 women (358,242 person-screenings) who participated in the Miyagi Cancer Society Screening program between 1 April 1995 and 31 December 2002 with the Miyagi Prefectural Cancer Registry, 429 MMG with CBE, 522 CBE, and 3,047 self-detected cases were included in this study. Follow-up was performed until the date of death or 31 December 2007. Survival was estimated by the Kaplan–Meier method. The Cox proportional hazards model was used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for breast cancer death.

Results

Five-year survival for women in the MMG with CBE, CBE, and self-detection groups was 96.8, 92.7, and 86.6 %, respectively. The HR (95 % CI) for breast cancer death was 2.38 (0.72–7.94) among CBE-screened and 4.44 (1.42–13.89) among self-detected cases for women aged 40–49 years, but was 3.00 (1.63–5.50) among CBE-screened and 4.51 (2.69–7.56) among self-detected cases for women aged 50–69 years relative to cases screened by use of MMG with CBE.

Conclusions

In terms of the survival and risk of breast cancer death, MMG with CBE may be more effective than MMG alone or self-detection for Japanese women aged 40–69 years.     

Efficacy of screening in preventing cervical cancer among older women

Background

Although the effectiveness of cervical cancer screening has been firmly established in reproductive-age women, its usefulness in older women is unclear. We sought to evaluate the efficacy of cervical cancer screening in older women.

Methods

We conducted a case–control study within two integrated health care systems in the northwestern United States. Cases (n = 69) were women aged 55–79 years who were diagnosed with invasive cervical cancer during 1980–1999. Controls (n = 208) were women with an intact uterus and no diagnosis of cervical cancer, but otherwise similar to cases in terms of age and length of enrollment in the health plan. We reviewed medical records to ascertain screening history during the 7 years prior to reference date.

Results

Compared to cases, controls were more likely to have received a Pap test. After adjustment for age and current smoking status, screening prior to an estimated 1-year duration of the occult invasive phase of cervical cancer was associated with a substantial reduction in risk [odds ratio (OR) 0.23; 95 % CI 0.11–0.44]. Similar results were obtained using different estimates of the duration of the occult invasive phase. Analysis of the relative incidence of invasive cervical cancer in relation to the time following a negative screening test suggested a large reduction during the first year (OR 0.09; 95 % CI 0.03–0.24). The incidence remained low for several years thereafter, returning to the incidence among unscreened women after 5–7 years.

Conclusions

Cervical cancer screening by means of cytology is highly efficacious in older women. Our findings also suggest that five-yearly screening is approximately as efficacious as more frequent screening.     

Diabetes and prostate cancer screening in black and white men

Purpose

Prior studies conducted primarily among white men find a reduced risk of prostate cancer associated with time since developing diabetes. While biologic explanations are plausible, the association may in part arise from more frequent prostate cancer screening among those with a diabetes diagnosis. The purpose of the present study was to investigate the association between diabetes and prostate cancer screening.

Methods

We examined differences in prostate cancer screening (prostate-specific antigen and/or digital rectal examination) testing practices after a diabetes diagnosis among lower-income persons living in the southeastern United States and enrolled in the Southern Community Cohort Study between 2002 and 2009. Baseline in-person interviews collected information on history of diabetes and prostate cancer screening from 18,809 black and 6,404 white men aged 40–79 years.

Results

After adjustment for confounding, diabetic black [odds ratio (OR) 1.12, 95 % confidence interval (CI) 1.01–1.25] and white (OR 1.25, 95 % CI 1.03–1.51) men were more likely to undergo recent prostate cancer screening compared to non-diabetic men of the same race. The increased risk for prostate cancer screening, however, occurred primarily within the first 12 months after diabetes diagnosis.

Conclusions

Our results suggest that a diabetes diagnosis modestly increases the likelihood of having a prostate cancer screening test for both black and white men. The prevalence of screening was higher nearer to the time of diabetes diagnosis, which may contribute to an early increase in prostate cancer detection followed by lower prostate cancer detection after an extended time.     

Colonoscopy reduced distal colorectal cancer risk and excess cancer risk associated with family history

Purpose

Colonoscopy efficacy at preventing proximal colorectal cancer (CRC) is questioned, and little is known about efficacy in high-risk versus medium-risk populations. We investigated the relationship between colonoscopy screening, family history of colorectal cancer (FHCC), and CRC risk by site.

Methods

Among 92,078 women of the E3N prospective cohort, 692 CRCs have been diagnosed after a median follow-up of 15.4 years. Cox proportional hazard models estimated adjusted hazards ratios according to subsites of cancer and FHCC.

Results

A personal history of colonoscopy (PHC; n = 37,470) was associated with decreased rectal and distal colon cancer risks (hazard ratio (HR) = 0.57; 95 % Confidence Interval (CI) = 0.42–0.78 and HR = 0.37; 95 % CI = 0.26–0.52, respectively), but not proximal colon cancer risk (HR = 0.87; 95 % CI = 0.64–1.18). In women with no prior colonoscopy, those with FHCC had a 80 % higher CRC risk than those without FHCC. In women with previous colonoscopy, CRC risk was similar in women with and without FHCC (p for interaction = 0.04).

Conclusions

Results showed colonoscopy ability to prevent distal cancers, but not proximal cancers in women. Colonoscopy screening also reduced the excess risk of women with FHCC to that of women with no FHCC.     

Prospective cohort studies of bowel movement frequency and laxative use and colorectal cancer incidence in US women and men

Purpose

The associations between bowel movement frequency, laxative use, and colorectal cancer incidence remain uncertain. No published studies have accounted for potential latency between these factors and colorectal cancer onset.

Methods

We prospectively examined these associations among 88,173 women in the Nurses’ Health Study (NHS, 1982–2010) and 23,722 men in the Health Professionals Follow-up Study (HPFS, 2000–2010). Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs, 95 % CIs). We conducted time lagged analyses to evaluate the potential latency in the NHS.

Results

We documented 2,012 incident colorectal cancer cases. The HRs (95 % CIs) for infrequent bowel movement relative to daily were 0.86 (95 % CI 0.71–1.04) in women and 0.81 (95 % CI 0.48–1.37) in men. The HRs for weekly to daily relative to never laxative use were 0.98 (95 % CI 0.81–1.20) in women and 1.41 (95 % CI 0.96–2.06) in men. In women, the HRs for every 3 days or less bowel movement relative to daily were 0.87 (95 % CI 0.59–1.27) for colorectal cancers that developed within 10 years of assessment, 1.03 (95 % CI 0.85–1.26) for 11–18 years after assessment, and 0.73 (95 % CI 0.54–1.01) for 19–28 years after assessment. The corresponding HRs for weekly to daily relative to never laxative use were 0.93 (95 % CI 0.63–1.37), 1.03 (95 % CI 0.74–1.44), and 0.98 (95 % CI 0.71–1.35), respectively.

Conclusion

Bowel movement frequency and laxative use appear not to be associated with colorectal cancer risk in this study.     

Mortality outcome among medically underserved women screened through a publicly funded breast cancer control program, 1997–2007

Purpose

The purpose of this study was to assess treatment and mortality differences between women diagnosed with breast cancer through Nebraska’s Every Woman Matters (EWM) program and women diagnosed through other sources.

Methods

A retrospective analysis was performed using 10 years of Nebraska Cancer Registry and EWM program data on women aged 40–74 years. This study used chi-square and multivariate logistic regression with mortality as the outcome of interest.

Results

From 1997 to 2007, 4,739 women were diagnosed with breast cancer, 435 (9.1 %) of whom were diagnosed through EWM. The EWM and non-EWM groups differed significantly in age, race, marital status, location of residence at the time of diagnosis, neighborhood poverty level at the time of diagnosis, tumor stage at diagnosis, and chemotherapy. No significant differences were found between the two groups in radiation therapy, surgical resection, and hormone therapy. In both 1- and 5-year multivariate mortality models, the odds of dying for those in the EWM program were not statistically significantly different from the odds of dying for those not in the EWM program. In the 1-year mortality model, residents of urban metropolitan counties (OR 2.079; 95 % CI 1.663–2.598) had an increased odds of dying compared to residents of rural counties. In the 5-year mortality model, black women (OR 2.239; 95 % CI 1.453–3.450), residents of areas with a high (more than 20 %) neighborhood poverty level at the time of diagnosis (OR 1.589; 95 % CI 1.204–2.097), and unmarried women (OR 1.334; 95 % CI 1.164–1.528) had higher odds of death. Both groups have received similar treatments.

Conclusions

Targeted outreach to vulnerable groups for cancer screening may improve cancer outcomes and reduce disparities.     

Total calcium intake and colorectal adenoma in young women

Background

Total calcium intake appears to reduce occurrence of colorectal adenoma; however, the dose necessary for prevention in young women is unclear. We examined fine categories of calcium intake in relation to occurrence of first colorectal adenoma in a cohort of mostly premenopausal (88 %) women aged 26–60 at time of endoscopy.

Design

We conducted an analysis among 41,403 participants in the Nurses’ Health Study II and assessed intakes of calcium prior to endoscopy through participants’ responses to biannual questionnaires.

Results

Between 1991 and 2007, we documented 2,273 colorectal adenoma cases. There was a significant trend across categories of calcium intakes with lowest intakes suggestive of higher occurrence of adenoma (p = 0.03) and those in the distal colon (p = 0.03) and rectum (p = 0.04). Compared with 1,001–1,250 mg/day of calcium intake, ≤500 mg/day was suggestive of a modest increase in occurrence of adenoma (multivariable RR = 1.21, 95 % CI 0.90–1.61); there were also suggestions of an increased risk with >500 to ≤700 mg/day of calcium. The association between ≤500 mg/day of calcium intake and adenoma was stronger for multiple (RR = 2.27, 95 % CI 1.38, 3.72), large (≥1 cm) (RR = 2.01, 95 % CI 1.27, 3.21), and high-risk adenoma (≥1 cm or mention of villous histology/high-grade dysplasia) (RR = 1.76, 95 % CI 1.13, 2.72). No differences in associations were noted between jointly categorized calcium and phosphorus or magnesium intakes.

Conclusions

Our findings suggest that low intakes of calcium, <500 and possibly 500–700 mg/day, in younger women are associated with an increased risk of multiple and advanced colorectal adenoma.     

Association of diet with the risk of prostate cancer in Western Algeria

Aim

Prostate cancer (Pca) is the most common cancer in men. Etiology of Pca is unknown. However, dietary factors are suspected. A case-control study was carried out in western Algeria to assess a possible association of diet with the risk of Pca.

Procedure

The study population consisted of 160 patients, aged 50-74 years, with histologically confirmed Pca and controls were 160 men of the same age group.

Results

Positive findings were obtained for the consumption of red meat (OR: 2.1, 95% CI: 1.1–3.9) and dairy products (OR: 2.2, 95% CI: 1.2–4.1), whereas the consumption of olive oil (OR: 0.5, 95%CI: 0.3–1.1) and green tea (OR: 0.6, 95% CI: 0.3–1.1) were negatively associated with Pca.

Conclusion

The risk was not statistically associated with all foods selected in this study. Possible mechanisms are discussed.     

Pooled cohort study on height and risk of cancer and cancer death

Purpose

To assess the association between height and risk of cancer and cancer death.

Methods

The metabolic syndrome and cancer project is a prospective pooled cohort study of 585,928 participants from seven cohorts in Austria, Norway, and Sweden. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for cancer incidence and death were estimated in height categories and per 5-cm increment for each cancer site using Cox proportional hazards model.

Results

During a mean follow-up of 12.7 years (SD = 7.2), 38,862 participants were diagnosed with cancer and 13,547 participants died of cancer. Increased height (per 5-cm increment) was associated with an increased overall cancer risk in women, HR 1.07 (95 % CI 1.06–1.09), and in men, HR 1.04 (95 % CI 1.03–1.06). The highest HR was seen for malignant melanoma in women, HR 1.17 (95 % CI 1.11–1.24), and in men HR 1.12 (95 % CI 1.08–1.19). Height was also associated with increased risk of cancer death in women, HR 1.03 (95 % CI 1.01–1.16), and in men, HR 1.03 (95 % CI 1.01–1.05). The highest HR was observed for breast cancer death in postmenopausal women (>60 years), HR 1.10 (95 % CI 1.00–1.21), and death from renal cell carcinoma in men, HR 1.18 (95 % CI 1.07–1.30). All these associations were independent of body mass index.

Conclusion

Height was associated with risk of cancer and cancer death indicating that factors related to height such as hormonal and genetic factors stimulate both cancer development and progression.     

Diabetes and colorectal cancer screening among men and women in the USA: National Health Interview Survey: 2008, 2010

Purpose

Adults with diabetes are at increased risk of being diagnosed with and dying from colorectal cancer, but it is unclear whether colorectal cancer screening (CRCS) use is lower in this population. Using the 2008 and 2010 National Health Interview Survey data, we examined whether guideline-concordant CRCS is lower among men and women with self-reported diabetes.

Methods

We calculated the weighted percentage of guideline-concordant CRCS and unadjusted and adjusted prevalence ratios (PR) comparing adults aged 51–75 years with diabetes (n = 6,514) to those without (n = 8,371). We also examined effect modification by age (51–64 and 65–75), race/ethnicity, and number of medical office visits (0–3, ≥4).

Results

The unadjusted prevalence of CRCS among men with diabetes was significantly higher than men without (63.3 vs. 58.0 %; PR = 1.09 95 % CI 1.03–1.16). In adjusted models, this relationship was evident among older [adjusted PR (aPR) = 1.13 95 % CI 1.06–1.21] but not younger men (aPR = 0.99 95 % CI 0.91–1.08; p for interaction term ≤0.01). There was no significant association between diabetes and CRCS among women overall (56.6 vs. 57.9 %; PR = 0.98 95 % CI 0.92–1.04) or by age group. Race/ethnicity and the number of medical visits did not significantly modify the association between diabetes and CRCS for men or women.

Conclusions

Men and women with self-reported diabetes were not less likely to be up to date with CRCS than those without diabetes. Older men with diabetes were more likely to be up to date with CRCS than those without diabetes.     

Physical activity and other lifestyle factors in relation to the prevalence of colorectal adenoma: a colonoscopy-based study in asymptomatic Koreans

Purpose

To evaluate physical activity and other lifestyle risk factors in relation to the prevalence of colorectal adenomas in asymptomatic Koreans.

Methods

A total of 1,526 asymptomatic subjects who underwent a colonoscopy were enrolled. Lifestyle factors such as physical activity and smoking data were obtained using a questionnaire. The subjects were grouped into three exposure levels by tertiles of metabolic equivalent hours per week. We evaluated the risk factors in subjects with adenomas by risk stratification (low-risk adenoma group vs. high-risk adenoma group) and by anatomic location (proximal colon, distal colon, rectum, and multiple locations). The high-risk adenoma group was defined as subjects with advanced adenomas or multiple (≥3) adenomas.

Results

A total of 456 participants had colorectal adenomas, and 861 had no polyps. In multivariate analyses, higher levels of physical activity were associated with a significantly decreased risk of colorectal adenomas (OR = 0.56, 95 % CI 0.40–0.79). This inverse association was stronger for the risk of high-risk adenomas (OR = 0.39, 95 % CI 0.21–0.73) than for low-risk adenomas (OR = 0.62, 95 % CI 0.43–0.89). The negative relation of physical activity was significant for distal colon adenomas (OR = 0.54, 95 % CI 0.30–0.95) and the adenomas with multiple locations (OR = 0.39, 95 % CI 0.21–0.72).

Conclusions

Increased physical activity is associated with a reduced prevalence of colorectal adenomas. The inverse association between physical activity and adenoma was stronger for the risk of advanced or multiple adenomas.     

Assessment of potential risk factors for breast cancer in a population in Southern Brazil

Purpose

The aim of this study is to assess potential risk factors for breast cancer in a population in Southern Brazil and build a multivariate logistic model using these factors for breast cancer risk prediction.

Methods

A total of 4242 women between 40 and 69 years of age without a history of breast cancer were selected at primary healthcare facilities in Porto Alegre and submitted to mammographic screening. They were evaluated for potential risk factors.

Results

In all, 73 participants among the 4242 women had a breast cancer diagnosis during the follow-up of the project (10 years). The multivariate analysis considering all the patients aged 40–69 years showed that older age (OR 1.08, 95% CI 1.04–1.12), higher height (OR 1.04, 95% CI 1.01–1.09), and history of previous breast biopsy (OR 2.66, 95% CI 1.38–5.13) were associated with the development of breast cancer. Conversely, the number of pregnancies (OR 0.87, 95% CI 0.78–0.98) and use of hormone replacement therapy (OR 0.39, 95% CI 0.20–0.75) were considered a protective factor. Additionally, we performed an analysis separating the participants into groups of 40–49 and 50–69 years old, since a risk factor could have a specific behavior in these age groups. No additional risk factors were identified within these age brackets, and some factors lost statistical significance.

Conclusion

The risk prediction model indicates that the following variables should be assessed in this specific population: age, height, having had previous breast biopsies, number of pregnancies, and use of hormone replacement therapy. These findings may help to better understand the causal model of breast cancer in Southern Brazil.

     

Racial disparities in advanced-stage colorectal cancer survival

Purpose

African-Americans (AA) have a higher incidence of and lower survival from colorectal cancer (CRC) compared with European Americans (EA). In the present study, statewide, population-based data from South Carolina Central Cancer Registry are used to investigate the relationship between race and age on advanced-stage CRC survival.

Methods

The study population was comprised of 3,865 advanced pathologically documented colon and rectal adenocarcinoma cases diagnosed between 01 January 1996 and 31 December 2006: 2,673 (69 %) EA and 1,192 (31 %) AA. Kaplan–Meier methods were used to generate median survival time and corresponding 95 % confidence intervals (CI) by race, age, and gender. Factors associated with survival were evaluated by fitting Cox proportional hazards regression models to generate hazard ratios (HR) and 95 % CI.

Results

We observed a significant interaction between race and age on CRC survival (p = 0.04). Among younger patients (<50 years), AA race was associated with a 1.34 times (95 % CI 1.06–1.71) higher risk of death compared with EA. Among older patients, we observed a modest increase in risk of death among AA men compared with EA [HR 1.16 (95 % CI 1.01–1.32)] but no difference by race between women [HR 0.94 (95 % CI 0.82–1.08)]. Moreover, we observed that the disparity in survival has worsened over the past 15 years.

Conclusions

Future studies that integrate clinical, molecular, and treatment-related data are needed for advancing understanding of the racial disparity in CRC survival, especially for those <50 years old.     

Body size in early life and breast cancer risk in African American and European American women

Purpose

There is growing evidence that body size in early life influences lifetime breast cancer risk, but little is known for African American (AA) women.

Methods

We evaluated body size during childhood and young adulthood and breast cancer risk among 1,751 cases [979 AA and 772 European American (EA)] and 1,673 controls (958 AA and 715 EA) in the Women’s Circle of Health Study. Odds ratio (OR) and 95 % confidence intervals (CI) were computed using logistic regression models while adjusting for potential covariates.

Results

Among AA women, being shorter at 7–8 years compared to peers was associated with increased postmenopausal breast cancer risk (OR 1.68, 95 % CI 1.02–2.74), and being heavier at menarche with decreased postmenopausal breast cancer risk, although of borderline significance (OR 0.45, 95 % CI 0.20–1.02). For EA women, being shorter from childhood through adolescence, particularly at menarche, was associated with reduced premenopausal breast cancer risk (OR 0.55, 95 % CI 0.31–0.98). After excluding hormone replacement therapy users, an inverse association with postmenopausal breast cancer was found among EA women reporting to be heavier than their peers at menarche (OR 0.18, 95 % CI 0.04–0.79). The inverse relationship between BMI at age 20 and breast cancer risk was stronger and only statistically significant in EA women. No clear association with weight gain since age 20 was found.

Conclusions

Findings suggest that the impact of childhood height on breast cancer risk may differ for EA and AA women and confirm the inverse association previously reported in EA populations with adolescent body fatness, in AA women.     

Occupational extremely low-frequency magnetic field exposure and selected cancer outcomes in a prospective Dutch cohort

Purpose

To investigate the association between exposure to occupational extremely low-frequency magnetic fields (ELF-MF) and the risk of a priori selected cancer outcomes within the prospective Netherlands Cohort Study.

Methods

120,852 men and women aged 55–69 years at time of enrollment in 1986 were followed up (17.3 years) for incident lung, breast and brain cancer, and hemato-lymphoproliferative malignancies. Information on occupational history and potential confounders such as sex, age, smoking, alcohol use, and attained educational level were collected at baseline through a self-administered questionnaire. Occupational ELF-MF exposure was assigned with a job-exposure matrix. Using a case-cohort approach, associations with cancer incidence were analyzed with Cox regression stratified by sex, using three exposure metrics: (1) ever had a job with low or high exposure to ELF-MF versus background, (2) duration of exposure, and (3) cumulative exposure.

Results

None of the exposure metrics showed an effect on incidence for lung, breast, and brain cancer, nor any of the assessed subtypes in men and women. Of the hemato-lymphoproliferative malignancies in men, ever high exposed to ELF-MF showed a significant association with acute myeloid leukemia (AML) [hazard ratio (HR) 2.15; 95 % confidence interval (CI) 1.06–4.35] and follicular lymphoma (FL) (HR 2.78; 95 % CI 1.00–5.77). Cumulative exposure to ELF-MF showed a significant, positive association with FL but not AML among men.

Conclusions

In this large prospective cohort study, we found some indications of an increased risk of AML and FL among men with occupational ELF-MF exposure. These findings warrant further investigation.     

Mammography utilization among Black and White Medicare beneficiaries in high breast cancer mortality US counties

Background

Disparities in US breast cancer mortality between older Black and White women have increased in the last 20 years. Regular mammography use is important for early detection and treatment: its utilization among older Blacks especially in counties with high Black mortality is of interest, but its extent and determinants are unknown.

Methods

We used Medicare claims for Black and White women 65–74 years old in 203 counties with the highest Black breast cancer mortality. Outcomes over 6 years were as follows: ever mammogram, i.e., ≥ 1 screening mammogram, and regular mammogram, i.e., ≥ 3 mammograms. With logistic regressions, we examined the independent effect of race on screening controlling for individual- and county-level factors.

Results

Of 406,602 beneficiaries, 17 % were Black. Ever and regular mammogram was significantly lower among Blacks (51.6 vs. 56.9 %; 32.9 vs. 43.1 %, respectively). Controlling for covariates, including use of cervical cancer screening, flu shots, or lipids tests, Black women were more likely to have ever mammogram (OR 1.23, CI 1.20–1.25), but not regular mammogram (OR 0.95, CI 0.93–0.97) than White women. County-level managed care penetration was negatively associated with ever and regular mammograms.

Conclusions

In Medicare enrollees from these counties, breast cancer screening was low. Black women had same or better odds of screening than White women. Some health care factors, e.g., managed care, were negatively associated with screening. Further studies on the determinants of mammography utilization in older women from these counties are warranted.     

Physical activity and risk of pancreatic cancer in a central European multicenter case–control study

Purpose

Findings from epidemiological studies examining physical activity in relation to pancreatic cancer risk have suggested decreased risks for physical activity; however, the results are inconsistent.

Methods

The association between occupational and leisure-time physical activity and risk of pancreatic cancer was examined among 826 pancreatic cancer cases and 930 age-, sex- and center-matched controls from a large multicenter central European study in Czech Republic and Slovakia recruited between 2004 and 2012. Data on physical activity including type and dose (frequency, intensity, and duration) were examined using multivariable-adjusted logistic regression models.

Results

Occupational physical activity was not significantly associated with risk of pancreatic cancer [odds ratio (OR) 0.90, 95 % confidence interval (CI) 0.71–1.15]. A 35 % decrease in risk of pancreatic cancer was observed for regular leisure-time physical activity (OR 0.65, 95 % CI 0.52–0.87). The risk estimates were significant for low and moderate intensity of activity with the strongest protective effect among individuals who exercised during more than 40 weeks per year. The results for cumulated leisure-time physical activity assessed 1 year prior to diagnosis achieved the same level of risk reduction. In addition, stronger risk estimates for leisure-time physical activity were observed among women (men: OR 0.74, 95 % CI 0.54–1.01; women: OR 0.53, 95 % CI 0.37–0.75). The findings for female participants were stronger for intensity and frequency of leisure-time physical activity, in particular for light and moderate activity (OR 0.43, 95 % CI 0.25–0.75; and OR 0.57, 95 % CI 0.37–0.88, respectively).

Conclusion

These results provide evidence for a decreased risk of pancreatic cancer associated with regular leisure-time physical activity.     

Is clinical breast examination effective in Japan? Consideration from the age-specific performance of breast cancer screening combining mammography with clinical breast examination

Background

There is controversy about the value of clinical breast examination (CBE) in breast cancer screening programs that include mammography.

Methods

In Fukui Prefecture, a screening combining mammography with CBE was employed on 62,447 women from 2004 to 2009. We examined the sensitivity and specificity of mammography alone, and mammography and CBE together for each age group (40–49, 50–59, 60–69, and 70–79).

Results

167 breast cancers and 49 false-negative cancers were detected during 5 years. For the combined screening, the sensitivities were 73.1, 74.1, 78.3, and 86.5 %, and the specificities were 83.8, 87.5, 89.8, and 90.9 % in the groups of 40–49, 50–59, 60–69, and 70–79 years, respectively. In the mammography-specific analysis, sensitivity decreased to 69.8 % (?3.3 %), 66.7 % (?7.7 %), 77.3 % (?1.0 %), and 83.8 % (?2.7 %) in the groups of 40–49, 50–59, 60–69, and 70–79 years, respectively. There were greater reductions in the groups of 40–49 and 50–59 years than in those of 60–69 and 70–79 years, but there was no statistically significant decrease. Specificity generally increased with increasing age and there was a significant improvement in specificity among all age groups, except that of 70–79 years.

Conclusions

Our findings suggest that there is a trade-off between sensitivity and specificity associated with CBE added to mammography. This tendency is greater in those 40–50 years of age than in those 60–70 years of age. We consider that CBE may be omitted from breast cancer screening among women aged 60 and 70 years. Furthermore, another modality to complement mammography screening in younger Japanese women is expected.