Cancer Risk in Women Exposed to Diethylstilbestrol In Utero

Context.— The association between in utero exposure to diethylstilbestrol (DES) and clear cell adenocarcinoma (CCA) of the vagina and cervix is well known, yet there has been no systematic study of DES-exposed daughters to determine whether they have an increased risk of other cancers. As many as 3 million women in the United States may have been exposed to DES in utero. Objective.— To determine whether women exposed to DES in utero have a higher risk of cancer after an average of 16 years of follow-up. Design.— A cohort study with mailed questionnaires and medical record review of reported cancer outcomes. Participants.— A cohort of 4536 DES-exposed daughters (of whom 81% responded) and 1544 unexposed daughters (of whom 79% responded) who were first identified in the mid-1970s. Main Outcome Measures.— Cancer incidence in DES-exposed daughters compared with population-based rates and compared with cancer incidence in unexposed daughters. Results.— To date, DES-exposed daughters have not experienced an increased risk for all cancers (rate ratio, 0.96; 95% confidence interval [CI], 0.58-1.56) or for individual cancer sites, except for CCA. Three cases of vaginal CCA occurred among the exposed daughters, resulting in a standardized incidence ratio of 40.7 (95% CI, 13.1-126.2) in comparison with population-based incidence rates. The rate ratio for breast cancer was 1.18 (95% CI, 0.56-2.49); adjustment for known risk factors did not alter this result. Conclusions.— Thus far, DES-exposed daughters show no increased cancer risk, except for CCA. Nevertheless, because exposed daughters included in our study were, on average, only 38 years old at last follow-up, continued surveillance is warranted to determine whether any increases in cancer risk occur during the menopausal years.      

METHOTREXATE AND PREDNISOLONE TREATMENT OF A CHILD WITH PSORIATIC ARTHRITIS

ABSTRACT: Björksten, B. and Bäck, O. (Department of Paediatrics and Dermatology University Hospital, Umeå, Sweden) Methotrexate and prednisolone treatment of a child with psoriatic arthritis. Acta Paediatr Scand, 64:664, 1975–A case of severe psoriasis and psoriatic arthritis in a child is presented. Only one detailed report has been published previously. The result of treatment with prednisolone and methotrexate was encouraging.     

Forced vital capacity and the risk of hypertension. The Normative Aging Study

This report describes the development of hypertension among 1,270 males (aged 23-80 years at the time of entry into the study) observed prospectively for 10 years who had a baseline blood pressure of less than 140/90 mmHg and who underwent baseline spirometry. Subjects were participants in the Normative Aging Study, a longitudinal study on aging initiated in 1961 at the Veterans Administration Outpatient Clinic in Boston, Massachusetts. Blood pressures were taken at five- and 10-year follow-up examinations. The age-adjusted incidence of hypertension during the follow-up period was found to be inversely related to forced vital capacity. Multiple logistic regression was employed to assess the relation of forced vital capacity to the subsequent development of hypertension after controlling for baseline levels of age, weight, cigarettes smoked per day, and systolic and diastolic blood pressures. Forced vital capacity was a statistically significant and negative predictor, indicating that lower values of forced vital capacity were associated with the subsequent development of hypertension. This was consistently found in several logistic regression analyses with a standardized odds ratio associated with forced vital capacity of approximately 0.7. Although the physiologic mechanism for this association is unknown, these findings may have importance in identifying subjects at risk and may also provide insight into disease pathogenesis.     

An investigation of bias in a study of nuclear shipyard workers

The authors examined discrepant findings between a 1978 proportional mortality study and a 1981 cohort study of workers at the Portsmouth, New Hampshire, Naval Shipyard to determine whether the healthy worker effect, selection bias, or measurement bias could explain why only the proportional mortality study found excess cancer deaths among nuclear workers. Lower mortality from noncancer causes in nuclear workers (the healthy worker effect) partly accounted for the observed elevated cancer proportional mortality. More important, however, was measurement bias which occurred in the proportional mortality study when nuclear workers who had not died of cancer were misclassified as not being nuclear workers based on information from their next of kin, thereby creating a spurious association. Although the proportional mortality study was based on a small sample of all deaths occurring in the cohort, selection bias did not contribute materially to the discrepant results for total cancer deaths. With regard to leukemia, misclassification of occupation in the proportional mortality study and disagreement about cause of death accounted for some of the reported excess deaths.