Oral contraceptives, tobacco smoking, and breast cancer risk.
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Biomedical subjects
Publications and source records attributed to D Trichopoulos.
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Eighty-three women with invasive adenocarcinoma of the endometrium and 164 control women hospitalized for various orthopedic conditions were interviewed regarding demographic, reproductive, socio-economic and biomedical characteristics, including their use of tobacco, drugs and exogenous estrogens. The data were analyzed by modelling rate ratio (r) through multiple logistic regression. The main results were as follows: women with invasive adenocarcinoma of the endometrium had earlier menarche (r = 0.82 for every additional year; one-tailed p approx. 0.04), later menopause (r = 1.50 for a 5-year difference; one-tailed p approx. 0.004), and fewer live-born children (r = 0.86 for every additional child; one-tailed p approx. 0.08); they were also taller (r = 1.33 for a 5-cm difference; one-tailed p approx 0.03), whereas weight, adjusted for height, was not a statistically significant risk indicator (one-tailed p approx. 0.38). Regular use of combination oral contraceptives was associated with a reduced risk of endometrial cancer (r = 0.56), whereas intake of menopausal estrogens for more than 6 months was associated with an increased risk (r = 2.04); however, because of the low frequency of use of exogenous estrogen preparations in Greece, neither of these 2 results was statistically significant. Tobacco smoking was associated with a significantly reduced risk of endometrial cancer; smoking 15-20 cigarettes per day for 20 years was associated with a rate ratio of 0.49 (one-tailed p approx. 0.03). The protective effect of tobacco smoking was evident only among post-menopausal women. These results indicate that the risk profile of endometrial cancer is similar in high-risk and low-risk countries, and underline the importance of unopposed estrogenic stimulation in the pathogenesis of this cancer.
One hundred forty-one retired Greek mariners were examined radiologically for asbestos-related lung disease. Thirty-eight (27%) had small opacities classified as ILO category 1/0 or more; 37 (26%) had radiologic evidence of pleural lesions; 17 (12%) had both parenchymal and pleural lesions; and a total of 58 (41%) had one or more radiologic findings of asbestos-related lung disease. In discriminant analysis, duration of maritime employment was predictive of pleural lesions, but the association was not statistically significant (one-tail, p = .16). The prevalence of pleural lesions was also higher among sailors than among officers, and this association was statistically significant (one-tail, p = .05). In this group, none of the occupational variables studied (age, duration of maritime employment, and rank) was related to lung fibrosis. After controlling by multiple regression for mutual confounding effects, suggestive negative associations for the presence of pleural lesions were found with FVC (one-tail, p = .13) as well as with FEF25% (one-tail, p = .09) and FEF50% (one-tail, p = .07). By contrast, no association was found between pulmonary fibrosis and any of the respiratory volumes. The results of this study suggest that mariners may present evidence of asbestos-related disease after many years from onset of exposure on ships.
This article reviews the epidemiology of cancer of the pancreas, both descriptive and analytical, at all times cognizant of the problems of misdiagnosis, particularly underdiagnosis, of this lethal disease that continue to hinder epidemiological studies. Pancreas cancer is consistently reported to occur more frequently in men than in women, in blacks than in whites, and in urban rather than rural population groups. In some countries, the mortality rates continue to rise, whereas in others, declining levels of disease can be seen among members of younger birth cohorts. Although some of these patterns can be explained by variation in pancreas cancer risk factors, many cannot. Analytical studies consistently demonstrate that cigarette smoking increases the risk of cancer of the pancreas, and this appears, at the present time, to be the only clearly demonstrated risk factor for pancreatic cancer. Although the association with disease risk and coffee consumption, alcohol consumption, occupational exposures, diabetes, pancreatitis, and other factors requires clarification, it appears likely that the most fruitful research area in the coming years may involve exploration of pancreatic cancer risk and nutritional practices.
Exposure of children of the Greek town of Lavrion to lead and cadmium has been evaluated by determination of the levels of lead (PbB) and cadmium (CdB) in the blood of 514 children living in the town. The Lavrion area is heavily polluted by lead owing to the presence of a large lead-zinc mining and smelting industrial complex. The industrial PbB level (geometric mean) was 21.7 micrograms dl-1 (range 7.4-79.8 micrograms dl-1). The CdB levels were, on average, 0.36 micrograms l-1 (range 0.1-3.1 micrograms l-1). The results were evaluated with respect to a number of constitutional, social and environmental variables, such as age, gender, distance of the school from the lead-zinc mining and smelting complex, and occupation and education of the father.
A case-control study concerning peripheral arterial occlusive disease (PAOD) was conducted in Athens, Greece. The case series consisted of 100 patients with PAOD as principle diagnosis admitted consecutively to a major teaching hospital in Athens during an 18-month period. The controls were patients hospitalized in the same hospital during the same period as the index cases for conditions requiring minor surgical care. All cases and controls were interviewed by the same person about several socioeconomic, demographic and medical variables; blood pressure and blood glucose values were also recorded. Data were analysed using multiple logistic regression procedures, controlling for age, sex and years of schooling. Tobacco smoking, systolic blood pressure, diabetes mellitus, heavy alcohol drinking and excessive coffee consumption were all strong independent risk factors with eight-fold or more differences in risk. It appears that PAOD as an atherosclerotic disease with low short-term fatality reveals in more contrasting terms the aetiological importance of factors involved in the atherosclerotic process as compared to atherosclerotic conditions with higher short-term fatality like coronary heart disease (CHD) which may also have stronger thrombotic components.
Socioeconomic factors are at least as important as narrowly defined medical care factors in determining the health status of the population. They also provide a stimulus for further research in the field of socioeconomic epidemiology.
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A number of risk factors for breast cancer are considered jointly in one pathogenetic framework which relates to the formation of pre-cancerous lesions. Energy-rich diet during puberty and adolescence enhances the occurrence of pre-cancerous lesions in the breast. This process is counteracted by full-term pregnancies, and the earlier they come the fewer the number of such lesions. Energy-rich diet later in life contributes to the occurrence of obesity which, after menopause, enhances the growth of existing subclinical and clinical breast cancer. In both periods of life the nutritional factor exerts its effect through endocrine mechanisms in which oestrogens play a major part.
A case-control study of the role of diet in the cause of breast cancer was conducted in Athens, Greece. The case series consisted of 120 consecutive patients with histologically confirmed breast cancer admitted to either of two teaching hospitals over a 12-month period. The controls were 120 patients admitted to a teaching hospital for trauma and orthopedic conditions during the same period. Dietary histories concerning the frequency of consumption of 120 foods and drinks were obtained by interview. Nutrient intakes for individuals were estimated by multiplying the nutrient content of a selected typical portion size for each specified food item by the frequency that the food was used per month and summing these estimates for all food items. Cases reported significantly less frequent consumption of vitamin A after controlling for total caloric intake, potential external confounding variables and other nutrients associated with breast cancer risk. The odds ratio estimated for consumption of vitamin A equal to the value of the 90th centile versus consumption equal to the value of the 10th centile was 0.46 with 90% confidence limits 0.26-0.82. There was no evidence that high intake of dietary fat increases the risk of breast cancer.
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Creatinine-adjusted levels of estrone, estradiol and estriol were determined in overnight urine specimens from 220 post-menopausal women, aged 54 to 66 years, from Boston (121 women) and Athens (99 women). The associations of individual and total estrogens with various characteristics of the women (age at menopause, years since menopause, parity, age at menarche, schooling, height, weight, tobacco smoking and alcohol drinking) were studied by multiple regression procedures, to explore possible relationships and evaluate their compatibility with the descriptive epidemiology of female breast cancer. Weight was consistently and significantly related to higher levels of total estrogens and of each individually; the pattern of these associations was similar in American and Greek women, suggesting that the known qualitative differences in nutrition between the two groups of women are not important modifiers of the associations between weight and estrogens. Estrogen levels in these post-menopausal women were about 40% of the corresponding follicular levels among teen-age women. They did not decrease with age. There were suggestive but non-significant negative associations between estrogen levels on the one hand, and parity and age at menarche on the other. There was no consistent association of estrogen levels with alcohol consumption. The data provide only modest support for the hypothesis that estrogens are important in breast cancer etiology.
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