Aspirin use and reduced risk of gastrointestinal tract cancers in the American Cancer Society prospective studies.
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American Cancer Society↗
Biomedical subjects
C W Heath
Publications and source records attributed to C W Heath.
Spontaneous abortion and risk of fatal breast cancer in a prospective cohort of United States women.
Controversy exists over the possible relationship between induced and spontaneous abortion and risk of breast cancer. Thus, the association of fatal breast cancer and spontaneous abortion was examined in a large prospective study of United States adult women. After seven years of follow-up, 1,247 cases of fatal breast cancer were observed among 579,274 women who were cancer-free at interview in 1982 and who provided complete reproductive histories. Results from Cox proportional hazards models, adjusted for other risk factors, showed no association between a history of spontaneous abortion and risk of fatal breast cancer (rate ratio [RR] = 0.89, 95 percent confidence interval [CI] = 0.78-1.02). The RR did not increase with increasing numbers of abortions. Parous women who had a spontaneous abortion before their first term birth were not at increased risk compared with parous women with no history of spontaneous abortion (RR = 0.76, CI = 0.54-1.05). Women whose only pregnancy ended in a spontaneous abortion were not at increased risk compared with women who were never pregnant (RR = 0.61, CI = 0.27-1.38) or whose only pregnancy ended in a livebirth (RR = 0.72, CI = 0.32-1.65). These findings do not support an association between spontaneous abortion and fatal breast cancer.
Abortion, Spontaneous↗
Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults.
Time-series, cross-sectional, and prospective cohort studies have observed associations between mortality and particulate air pollution but have been limited by ecologic design or small number of subjects or study areas. The present study evaluates effects of particulate air pollution on mortality using data from a large cohort drawn from many study areas. We linked ambient air pollution data from 151 U.S. metropolitan areas in 1980 with individual risk factor on 552,138 adults who resided in these areas when enrolled in a prospective study in 1982. Deaths were ascertained through December, 1989. Exposure to sulfate and fine particulate air pollution, which is primarily from fossil fuel combustion, was estimated from national data bases. The relationships of air pollution to all-cause, lung cancer, and cardiopulmonary mortality was examined using multivariate analysis which controlled for smoking, education, and other risk factors. Although small compared with cigarette smoking, an association between mortality and particulate air pollution was observed. Adjusted relative risk ratios (and 95% confidence intervals) of all-cause mortality for the most polluted areas compared with the least polluted equaled 1.15 (1.09 to 1.22) and 1.17 (1.09 to 1.26) when using sulfate and fine particulate measures respectively. Particulate air pollution was associated with cardiopulmonary and lung cancer mortality but not with mortality due to other causes. Increased mortality is associated with sulfate and fine particulate air pollution at levels commonly found in U.S. cities. The increase in risk is not attributable to tobacco smoking, although other unmeasured correlates of pollution cannot be excluded with certainty.
Air Pollutants↗
Excess mortality among cigarette smokers: changes in a 20-year interval.
OBJECTIVES: This study was undertaken to examine changes in smoking-specific death rates from the 1960s to the 1980s. METHODS: In two prospective studies, one from 1959 to 1965 and the other from 1982 to 1988, death rates from lung cancer, coronary heart disease, and other major smoking-related diseases were measured among more than 200,000 current smokers and 480,000 lifelong non-smokers in each study. RESULTS: From the first to the second study, lung cancer death rates (per 100,000) among current cigarette smokers increased from 26 to 155 in women and from 187 to 341 in men; the increase persisted after current daily cigarette consumption and years of smoking were controlled for. Rates among nonsmokers were stable. In contrast, coronary heart disease and stroke death rates decreased by more than 50% in both smokers and nonsmokers. The all-cause rate difference between smokers and nonsmokers doubled for women but was stable for men. CONCLUSIONS: Premature mortality (the difference in all-cause death rates between smokers and nonsmokers) doubled in women and continued unabated in men from the 1960s to the 1980s. Lung cancer surpassed coronary heart disease as the largest single contributor to smoking-attributable death among White middle-class smokers.
Adult↗
Nonsteroidal antiinflammatory drugs and human cancer. Report of an interdisciplinary research workshop.
BACKGROUND: Since the 1970s, work in several disciplines (toxicology, pharmacology, clinical medicine, epidemiology) increasingly has suggested that aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) may reduce the occurrence or progression of colorectal cancers and polyps and perhaps of other gastrointestinal tumors. The potential application of these findings for chemoprevention of such cancers in man now deserves serious consideration. METHODS: An interdisciplinary workshop was held by the American Cancer Society in March 1994 to review the current knowledge of NSAIDs and cancer and to seek a consensus on future research directions, particularly concerning the possibility of randomized prevention trials in human populations. RESULTS: A wide-ranging review was conducted of past and current research regarding (1) NSAIDs' effects in experimental animal cancer models; (2) clinic experience in NSAID treatment, particularly in familial polyposis; (3) pharmacologic studies regarding the enzymatic and metabolic actions of NSAIDs; and (4) epidemiologic observations on the relationship of aspirin/NSAID usage to colorectal cancer occurrence in human populations. CONCLUSIONS: Combined evidence from different research disciplines strongly supports the notion that aspirin and other NSAIDs act to prevent the development or progression of certain human gastrointestinal cancers, especially colorectal cancer. Consequently, the workshop recommended that randomized prevention trials be undertaken. For various logistic reasons, such trials probably should focus on NSAID effects on the occurrence and progression of colorectal polyps rather than on carcinoma itself. Continued research also is needed to clarify further the pharmacologic, clinical, and epidemiologic nature of NSAIDs' influences on human carcinogenesis.
Animals↗
Changing trends. An overview of breast cancer incidence and mortality.
The incidence of breast cancer rose about 1% per year between 1940 and 1980 according to data in the Connecticut Tumor Registry. A sharp increase of 32% was reported between 1980 and 1987 in the Surveillance, Epidemiology and End Results Program of the National Cancer Institute. Data from this program shows that the increase in incidence was due to localized cases and cancers of less than 2 cm in greatest dimension. In addition, a sharp increase in carcinoma in situ was observed. The increase in breast cancer incidence coincides with an increased use of mammography in asymptomatic women in the 1980s. Mortality from breast cancer has changed little since the 1930s, but the increases in localized and small-size tumors and decreases in the rate of tumors of 3 cm or larger at diagnosis indicates that breast cancer mortality may start to decrease. Evidence from provisional breast cancer monthly mortality data suggests that there was a 3-6% drop in 1991 compared to 1990.
Adult↗
Cigarette smoking and risk of fatal breast cancer.
The authors examined the association of fatal breast cancer and cigarette smoking in a large, prospective mortality study of US adults. After 6 years of follow-up, 880 cases of fatal breast cancer were observed in a cohort of 604,412 women who were cancer-free at interview in 1982. Cox proportional hazards modeling, adjusted for other risk factors, found that current smoking was significantly related to fatal breast cancer risk (adjusted rate ratio (RR) = 1.26, 95% confidence interval (CI) 1.05-1.50). A negative association was observed for former smokers, but this was not statistically significant (RR = 0.85, 95% CI 0.70-1.03). The association of current smoking with fatal breast cancer risk increased with increasing numbers of cigarettes per day and with total number of years smoked. For smokers of 40 or more cigarettes per day, the rate ratio was 1.74 (95% CI 1.15-2.62). The authors hypothesize that these results may be due to either a poorer prognosis among breast cancer cases who smoke or a delayed diagnosis among current smokers who do not receive mammograms as often as never or former smokers. Women who smoke should be targeted for breast cancer screening services.
Adult↗
Hair dye use and risk of fatal cancers in U.S. women.
BACKGROUND: Permanent hair dyes are used by about one third of adult American women. Several epidemiologic studies associate hair dye use with increased risk of non-Hodgkin's lymphoma and multiple myeloma. In one study, risk increased with more prolonged exposure to darker, more concentrated, permanent dyes. PURPOSE: The purpose of our study was to examine the relationship between hair dye use and development of certain cancers associated with hair dye use in previous studies. METHODS: We examined prospectively the relationship between the use of permanent hair dyes and selected fatal cancers in 573,369 women. The participants provided information in 1982 on the frequency and duration of hair dye use and the color of hair dye used. Death rates were measured through 1989. Relative risks (RRs) were computed with subjects who had not used hair dyes serving as the referent group, and 95% confidence intervals (CIs) were calculated on the basis of approximate-variance formulas. RESULTS: Women who had ever used permanent hair dyes showed decreased risk of all fatal cancers combined (RR = 0.93; 95% CI = 0.89-0.98) and of urinary system cancers (RR = 0.65; 95% CI = 0.49-0.87) and no increase in risk of any type of hematopoietic cancer. Women who had used black hair dyes for 20 years (0.6% of women hair dyers) or more had increased risk of fatal non-Hodgkin's lymphoma (RR = 4.37; 95% CI = 1.3-15.2) and multiple myeloma (RR = 4.39; 95% CI = 1.1-18.3). These positive findings are based on three cases of non-Hodgkin's lymphoma and two cases of multiple myeloma. We found no relationship between use of permanent hair dyes and fatal cancers of the mouth, breast, lung, bladder, or cervix, areas that were of interest as the result of earlier studies. CONCLUSIONS: Women using permanent hair dyes are not generally at increased risk of fatal cancer. Women with prolonged use of dark, particularly black, hair dyes may have increased risk of fatal non-Hodgkin's lymphoma and multiple myeloma, but these women are a small fraction of hair dye users. Nonetheless, the removal of carcinogens from hair dyes and appropriate labeling of hair-coloring products would help reduce this potential risk.
Adult↗
Family history, age, and risk of fatal breast cancer.
A family history of breast cancer potentially identifies women at high risk for whom mammography may be especially valuable. The authors examined the association of fatal breast cancer and family history in a large, prospective study of US adults. After 6 years of follow-up, 880 cases of fatal breast cancer were observed in a cohort of 604,412 women who were cancer free at interview in 1982. Cox proportional hazards modeling found that a family history of breast cancer in a mother or sister was significantly related to fatal breast cancer risk (rate ratio = 1.59, 95% confidence interval (CI) 1.29-1.95). The association was greatly modified by age; the rate ratio was 4.91 (95% CI 1.39-17.3) in women aged < 40 years at enrollment compared with 1.28 (95% CI 0.78-2.11) in women aged > or = 70 years. Among young (aged < 50 years) women, the risk associated with a positive family history was greatest if the relative was also young at the time of diagnosis (rate ratio = 5.22, 95% CI 3.00-9.11). These associations were not altered in multivariate analyses controlling for known breast cancer risk factors. In the authors' data, family history is strongly predictive of early fatal breast cancer, particularly when the disease is diagnosed before age 50 in the relative. Women with a family history of early breast cancer should receive special instructions regarding mammography and early detection.
Adult↗
Aspirin use and risk of fatal cancer.
Aspirin and other nonsteroidal antiinflammatory drugs inhibit prostaglandin synthesis and tumor growth in many experimental systems, but it is unclear which of these tumor models are relevant to humans. We have reported reduced risk of fatal colon cancer among persons who used aspirin in a large prospective study. This analysis examines other fatal cancers in relation to aspirin among 635,031 adults in that study who provided information in 1982 on the frequency and duration of their aspirin use and did not report cancer. Death rates were measured through 1988. Death rates decreased with more frequent aspirin use for cancers of the esophagus, stomach, colon, and rectum but not generally for other cancers. For each digestive tract cancer, death rates were approximately 40% lower among persons who used aspirin 16 times/month or more for at least 1 year compared to those who used no aspirin. The trend of decreasing risk with more frequent aspirin use was strongest among persons who had used aspirin for 10 years or more; it remained statistically significant, except for esophageal cancer, in multivariate analyses that adjusted for other known risk factors. Biases such as early detection or aspirin avoidance among cases do not appear to explain the results. Our data suggest that regular, prolonged use of aspirin may reduce the risk of fatal cancer of the esophagus, stomach, colon, and rectum. Future epidemiological and basic research should examine all digestive tract cancers in considering the chemopreventive or therapeutic potential of nonsteroidal antiinflammatory drugs.
Acetaminophen↗
Environmental tobacco smoke and lung cancer.
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Humans↗
Rheumatoid arthritis, aspirin, and gastrointestinal cancer.
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Anti-Inflammatory Agents, Non-Steroidal↗
Risk factors for fatal colon cancer in a large prospective study.
BACKGROUND: Diet, physical activity, obesity, aspirin use, and family history may all modify the risk of colon cancer, but few epidemiologic studies are large enough to examine these factors simultaneously. PURPOSE: We prospectively assessed the relationship of diet and other factors to risk of fatal colon cancer. METHODS: Using data from Cancer Prevention Study II--an ongoing prospective mortality study--we studied 764,343 adults who, in 1982, completed a questionnaire on diet and other risk factors and did not report cancer or other major illness. We assessed mortality through August 1988 and identified 1150 deaths from colon cancer (611 men and 539 women). Multivariate analyses were used to compare these case patients with 5746 matched control subjects drawn from the cohort. RESULTS: Risk of fatal colon cancer decreased with more frequent consumption of vegetables and high-fiber grains (P for trend = .031 in men and .0012 in women). The relative risk (RR) for the highest versus lowest quintile of vegetable intake was 0.76 in men (95% confidence interval [CI] = 0.57-1.02) and 0.62 in women (95% CI = 0.45-0.86). Dietary consumption of vegetables and grains and regular use of aspirin were the only factors having an independent and statistically significant association with fatal colon cancer. Participants who consumed the least vegetables and grains and no aspirin had a higher risk compared with those who consumed the most vegetables and used aspirin 16 or more times per month. For men in the former category, the RR was 2.4 (95% CI = 1.1-5.3); for women, it was 2.9 (95% CI = 1.3-6.7). Weaker associations were seen for physical inactivity, obesity, total dietary fat, and family history. No associations were seen with consumption of red meat or total or saturated fat in either sex, but this finding must be interpreted cautiously. CONCLUSIONS: These findings support recommendations that increased consumption of vegetables and grains may reduce the risk of fatal colon cancer. Regular use of low doses of aspirin may prove to be an important supplemental measure.
Adult↗
Biologic variations, incidence by age, and risk assessment of breast cancer screening outcomes.
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Adult↗
Epidemiologic studies of rheumatoid arthritis: future directions.
We (1) review the current status of epidemiologic studies of rheumatoid arthritis (RA); (2) consider the strengths and weaknesses of such studies and (3) offer suggestions regarding directions which future work might take. We will not examine any particular studies in great detail, but, instead, will focus on those broad aspects of epidemiologic work concerning RA which seem most important. In this process, it may be useful to draw comparisons with cancer epidemiology, since etiologic possibilities in cancer often resemble those seen in RA and similar methodologic issues are involved.
Arthritis, Rheumatoid↗
Aspirin use and reduced risk of fatal colon cancer.
BACKGROUND AND METHODS: Experiments in animals and two epidemiologic studies in humans suggest that aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) may be protective against colon cancer. We tested this hypothesis in a prospective mortality study of 662,424 adults who provided information in 1982 on the frequency and duration of their aspirin use. Death rates from colon cancer were measured through 1988. The possible influence of other risk factors for colon cancer was examined in multivariate analyses for 598 case patients and 3058 matched control subjects drawn from the cohort. RESULTS: Death rates from colon cancer decreased with more frequent aspirin use in both men and women. The relative risk among persons who used aspirin 16 or more times per month for at least one year was 0.60 in men (95 percent confidence interval, 0.40 to 0.89) and 0.58 in women (95 percent confidence interval, 0.37 to 0.90). The risk estimates were unaffected when we excluded persons who reported at entry into the study that they had cancer, heart disease, stroke, or another condition that might influence both their aspirin use and their mortality. Adjustment for dietary factors, obesity, physical activity, and family history did not alter the findings significantly. No association was found between the use of acetaminophen and the risk of colon cancer. CONCLUSIONS: Regular aspirin use at low doses may reduce the risk of fatal colon cancer. Whether this is due to a direct effect of aspirin, perhaps mediated by the inhibition of prostaglandin synthesis, or to other factors indirectly associated with aspirin use is unclear.
Acetaminophen↗
Cigarette smoking and hematopoietic cancer.
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Humans↗