Fluoride: benefits and risks of exposure. The preparation of a report.
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Dental Caries↗
Biomedical subjects
M C Mahoney
Publications and source records attributed to M C Mahoney.
Health and economic impact of cigarette smoking in New York State, 1987-1989.
This study provides estimates of deaths attributable to smoking, years of potential life lost (YPLL), and economic costs for each of New York's 57 counties and New York City for the period 1987 to 1989. Results show that in New York State, cigarette smoking was responsible for an average of 30,359 deaths, 409,129 YPLL, and nearly $4 billion in economic costs annually. Overall, smoking-attributable deaths comprised 17.7% of all deaths, or more than the combined total from accidents, AIDS, homicide, and suicide. Findings demonstrate the enormous health and economic burden caused by tobacco use and reinforce the need for policies that discourage smoking, such as increased cigarette taxes, limited smoking in public places, enforcement of youth tobacco access laws, and funding for tobacco education programs.
Adult↗
Cervical cancer control in minority women--more needs to be done.
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Female↗
Evidence for a spatiotemporal cluster of ovarian cancer cases.
Personal and lifestyle factors, rather than environmental factors, have been associated with the occurrence of ovarian cancer. An apparent spatiotemporal cluster of ovarian cancer cases was evaluated by comparing the observed and expected number of cases (1978-1988), examining morphologic data, reviewing medical records, and conducting an environmental survey of the study area. A statistically significant excess of ovarian cancer cases was noted (8 cases observed, 3.4 cases expected; P less than 0.025). Seven of the eight cases resided within 0.75 miles of each other at time of diagnosis; six cases were diagnosed within a 5-year interval. A morphologic review, medical record review, and environmental survey did not provide any possible reasons for this excess. It is hoped that this initial report will stimulate reports of similar observations by clinicians and health researchers in an effort to further elucidate etiologic factors in the development of ovarian cancer.
Aged↗
A meta-analysis of cancer incidence in United States and Canadian native populations.
A meta-analytic approach was used to summarize studies of cancer incidence among Native populations in the United States and Canada. Native males and females were found to have a significantly lower incidence of cancer for all sites combined. Among Native males, kidney cancer was found to exhibit significantly elevated incidence, while significantly lower incidence was found for cancers of the colon, lung, and prostate, and for lymphomas and leukaemias. Native females were found to have significantly elevated incidence for cancers of the gallbladder, cervix, and kidney, while significantly decreased incidence was found for cancers of the colon, breast and uterus, and for lymphomas. The use of meta-analysis to integrate the findings from these studies allowed the identification of subtle differences in cancer incidence. Although these findings are not definitive, they overcome the limited numbers of site-specific cancers reported in many previous studies and are suggestive of general patterns of cancer incidence among Native populations. In addition, these results may be useful in indicating directions for future research involving specific cancer sites with elevated incidence.
Canada↗
Breast cancer risk and oral contraceptive use: results from a large case-control study.
The association between oral contraceptive use and breast cancer risk was examined using data from a case-control study of breast cancer in Long Island, New York. Cases were defined as female residents of Nassau and Suffolk Counties between the ages of 20 and 79, diagnosed with breast cancer between January 1, 1984 and December 31, 1986. Age- and county-matched controls were selected from driver's license files. Among all women under age 70 at diagnosis, there was no association between oral contraceptive use and breast cancer; there was, however, a positive association in the subgroup ages 20-49 (adjusted odds ratio = 1.68, 95% CI: 1.16-2.42). Risk increased with increasing duration of use, but did not differ between women who first used oral contraceptives before the first pregnancy and those who first used them later, or between women who first used oral contraceptives before age 25 and those who first used them at a later age. Risk also appeared to increase with number of years of use before the first pregnancy or before age 25, although numbers were small. History of benign breast disease did not influence risk. The association of breast cancer risk with oral contraceptive use appeared stronger in women from Suffolk County than Nassau County.
Adult↗
Bone cancer incidence rates in New York State: time trends and fluoridated drinking water.
BACKGROUND: Recent animal studies of the potential carcinogenicity of fluoride prompted an examination of bone cancer incidence rates. METHODS: Trends in the incidence of primary bone cancers, including the incidence of osteosarcomas were examined among residents of New York State, exclusive of New York City. Average annual osteosarcoma incidence rates in fluoridated and non-fluoridated areas were also compared. RESULTS: Among persons less than 30 years of age at diagnosis, bone cancer incidence among males demonstrated a significant increase since 1955, while incidence among females has remained unchanged. A significant decrease in bone cancer incidence rates since 1955 was observed among both males and females age 30 years and over at time of diagnosis. Osteosarcoma incidence rates have remained essentially unchanged since 1970, among both younger and older males and females. The average annual age adjusted incidence of osteosarcomas (1976-1987) in areas served by fluoridated water supplies was not found to differ from osteosarcoma incidence rates in non-fluoridated areas. CONCLUSIONS: These data do not support an association between fluoride in drinking water and the occurrence of cancer of the bone.
Adult↗
The epidemiology of ophthalmic malignancies in New York State.
The epidemiologic characteristics of more than 1400 primary eye cancers (ICD-9, site 190) diagnosed among New York State (NYS) residents between 1975 and 1986 are described. Among NYS male residents, the average annual age-adjusted incidence rate was 7.5 per 1,000,000, and among NYS female residents, the rate was 5.4 per 1,000,000 (male:female rate ratio, 1.39). The majority of ophthalmic malignancies were included within three histologic groupings: melanomas (70.4%), retinoblastomas (9.8%), and squamous cell carcinomas (9.2%). The average annual incidence of retinoblastoma among persons in NYS who were less than 5 years of age was 9.5 per 1,000,000 for boys and 8.7 per 1,000,000 for girls (male:female rate ratio, 1.09). The average annual incidence (age-adjusted) of ocular melanomas was 4.9 per 1,000,000 among men and 3.7 per 1,000,000 among women in NYS (male:female rate ratio, 1.32). Expanded knowledge of the epidemiology of ophthalmic cancers can help to develop a foundation on which to monitor disease patterns and can serve to stimulate further etiologic research involving these rare malignancies.
Adolescent↗
Cancer in native populations--lessons to be learned.
Cancer incidence rates among Native Americans have, for the most part, been observed to be significantly lower than the general population. There has been, however, some indication that this is changing. The identification of emerging and changing patterns of cancer incidence in Natives is important in the establishment of cancer education, prevention, and screening programs. The present report attempts to put the Native cancer question into focus through a meta-analytic literature review; the presentation of a separate investigation of cancer mortality patterns in a single tribal group covering a 30-year period; and a brief review of cancer survival statistics for Natives. Meta-analytic results indicate that Native males and females experience a significantly lower incidence of cancer than expected. Females were found to experience an elevated risk of cervical cancer. Similar trends were observed in the separate mortality study. Moreover, mortality data indicate that there has been a trend towards increases in mortality from cancer, especially cancers of the lung, colon/rectum, and cervix. Natives experience significantly poorer relative survival rates for most cancer sites. Secular changes in cancer occurrence and mortality coupled with bleak survival statistics argue for the immediate establishment of effective cancer education and screening programs in these populations.
Cause of Death↗
Population density and cancer mortality differentials in New York State, 1978-1982.
Patterns of cancer mortality within five population density quintiles in Upstate New York (New York State, exclusive of New York City), were investigated between 1978 and 1982. Sex-specific standardized mortality ratios (SMRs) were calculated within each population density quintile for all cancer deaths combined and for site-specific cancer deaths based on cancer mortality patterns exhibited by the general population of New York State, exclusive of New York City. Areas with the highest population density demonstrated a 12% excess of cancer deaths among males and a 6% excess among females. In contrast, areas with the lowest population density exhibited lower cancer mortality, among both males (9% less) and females (7% less). Males demonstrated a significant linear relationship between increasing population density and deaths for all cancer sites combined and for cancers of the oral cavity and pharynx, oesophagus, stomach, colon, gallbladder, pancreas, lung, prostate, and kidney. Among females, a significant linear relationship was observed between increasing population density and deaths for all cancer sites combined and for deaths due to cancers of the stomach, colon, liver and breast. Deaths due to cancers of the rectum, malignant melanomas of the skin, and cervix also exhibited unusual patterns of mortality across the population density quintiles. These data are most useful in generating hypotheses for further studies to define specific aetiological factors operating within population density groupings. Population density, as measured in this investigation, may represent a surrogate measure for other factors which are related to cancer morbidity and cancer mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
Female↗
Fluoride: benefits and risks of exposure.
This summarizes current knowledge of the benefits and risks of fluoride ingestion. The preponderance of evidence indicates that fluoride can reduce the incidence of dental caries and that fluoridation of drinking water can provide such protection. Due to the ubiquitous nature of exposures to fluoride sources other than drinking water, it is currently impossible to draw firm conclusions regarding the independent effect of fluoride in drinking water on caries prevalence using an ecologic study design. Moderate dental fluorosis occurs in 1 to 2% of the population exposed to fluoride at 1 mg/l in drinking water and in about 10% of the population at 2 mg/l; moderate/severe fluorosis occurs in variable percentages ranging up to 33% of the population exposed to fluoride at 2.4 to 4.1 mg/l in drinking water. The issue of whether moderate or severe dental fluorosis represents an adverse health effect is still controversial. There is no evidence of skeletal fluorosis among the general U.S. population exposed to drinking water fluoride concentrations lower than 4 mg/l. Radiographically detected osteosclerosis after chronic exposure to fluoride in drinking water at 8 mg/l was not associated with clinical symptoms. Reports of crippling skeletal fluorosis associated with low concentrations of fluoride in drinking water in tropical countries have been attributed to other dietary factors. The available data suggest that some individuals may experience hypersensitivity to fluoride-containing agents. Further studies on hypersensitivity are required. There is no evidence of increased incidence of renal disease or renal dysfunction in humans exposed to up to 8 mg fluoride per liter in drinking water. Structural changes in kidneys of experimental animals have been detected at doses exceeding 1 to 5 mg fluoride per kilogram per day. Based on four case reports, individuals with renal insufficiency who consume large volumes of naturally fluoridated water at 2 to 8 mg/l are possibly at increased risk of developing skeletal fluorosis. Studies on the effects of fluoride in individuals with renal insufficiency are needed. There is no evidence that chronic exposure to concentrations of fluoride reported to be greater than 2 mg/l in drinking water increases human cancer mortality or incidence. A study of lifetime exposure to fluoride on cancer incidence in rats and mice has been completed, but assessment for cancer has not been completed. There is no evidence that fluoride is genotoxic except in some in vitro assays at cytotoxic concentrations. There is no in vivo evidence that fluoride affects human cellular enzyme activities.(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
CT demonstration of calcification in carcinoma of the lung.
Radiologic visualization of calcification within lung cancer is uncommon and may cause confusion and misdiagnosis. For this reason, we reviewed CT records of 353 patients undergoing initial evaluation of lung cancer for the presence of calcification within the tumor, both to document this finding and to estimate its prevalence. Twenty patients (6%) whose records indicated that CT showed calcification were identified, and their chest radiographs and CT scans were analyzed. Patients were included in the study if calcium was seen within the tumor on noncontrast pretreatment CT scans and if pathologic data were available. There were 15 lung and five mediastinal tumors. Fourteen were 5 cm or greater in diameter; three were between 3 and 5 cm, and three were 2 cm or smaller. Cell types of the tumors included small-cell carcinoma (eight patients), squamous cell carcinoma (seven patients), adenocarcinoma (four patients), and undifferentiated carcinoma (one patient). Patterns of calcification were amorphous (eight patients), punctate (10 patients), and reticular (two patients). Extent of tumor calcification and distribution (central, peripheral, or diffuse) did not correlate with cell type or size of the lesion. The visualization of calcium on chest radiographs and CT scans does not alone exclude the diagnosis of bronchogenic carcinoma.
Adenocarcinoma↗
Cancer mortality in a northeastern native American population.
This study compared cancer mortality among the Seneca Nation of Indians (SNI) between 1955 and 1984 with cancer patterns exhibited by the general population of New York State (NYS), exclusive of New York City. Cancer mortality among the SNI was compared with cancer mortality in NYS using age and sex standardized mortality ratios (SMR). Deficits in overall cancer mortality were noted among both SNI males (SMR = 78) and females (SMR = 73). Results from this investigation will contribute to the understanding of patterns of malignant disease mortality among native peoples and may be of benefit for monitoring the impact of cancer mortality among the SNI and other Native American groups.
Adolescent↗
Cancer surveillance in a northeastern native American population.
This study compares cancer incidence among the Seneca Nation of Indians (SNI) between 1955 and 1984 with cancer incidence patterns exhibited by the general population of New York State (NYS), exclusive of New York City. The cohort for this study consisted of all members of the SNI enrolled on January 1, 1955 and residing in NYS (N = 3262). Cancer incidence among the SNI is compared with cancer incidence patterns in NYS using age and sex standardized incidence ratios (SIR). Decreased cancer incidence was observed for all sites combined with SNI males exhibiting 64% of expected incidence and females exhibiting 53% of expected incidence. Although incidence deficits were observed for several sites, cancer incidence was not significantly elevated for any cancer site. Results from this investigation will contribute to the understanding of patterns of malignant disease among native peoples and aid in directing cancer control programs and services available to native groups.
Adolescent↗
A mortality analysis of Native American in New York State, 1980-86.
This investigation examined the mortality experience of Native Americans in New York State, exclusive of New York City, between 1980 and 1986. Compared to the general population of New York State, exclusive of New York City, deaths among Native Americans occurred an average of nine years earlier. Among Native males, elevated risk of death was noted for tuberculosis, diabetes mellitus, pneumonia and cirrhosis. Native females demonstrated an excess of deaths due to diabetes mellitus and cirrhosis. Fewer than expected malignant neoplasm deaths occurred among both Native males and females. A deficit of deaths was observed for colon and lung cancer deaths among Native males and for colon and breast cancer deaths among Native females. While these results are generally in agreement with previous reports, this study did not identify an excess of deaths due to accident-related mortality. Findings from this study, while limited, do serve as crude indicators of the overall health status of Native Americans in New York State and may prove useful in the context of planning and evaluating future health care services among this population.
Adolescent↗
Mortality in a northeastern Native American cohort, 1955-1984.
Patterns of mortality among members of the Seneca Nation of Indians between January 1, 1955, and December 31, 1984, were investigated. The study cohort consisted of all members of the Seneca Nation residing in New York State who were listed in the tribal rolls as of January 1, 1955 (n = 3,262). Deaths among cohort members were identified through a computer match against New York State vital records files. Sex-specific standardized mortality ratios (SMRs) were calculated on the basis of mortality patterns exhibited by the general population of New York State, exclusive of New York City. Seneca Nation males demonstrated an excess of deaths from all causes (SMR = 124), while all-cause mortality among Seneca Nation females did not differ from that expected (SMR = 106). Both males and females exhibited excess mortality from infectious diseases, diabetes mellitus, cirrhosis of the liver, and accidents and injuries. Excess mortality was also noted among males for deaths due to atherosclerosis and hernia/intestinal obstruction and among females for deaths due to pneumonia, chronic nephritis, and homicide. Both sexes exhibited a deficit of deaths due to malignant neoplasms and circulatory diseases. Findings from this study will be useful to those responsible for the planning and implementation of health care programs among the Seneca Nation of Indians and other Native American groups.
Cause of Death↗
Measurement of lifetime exposure to passive smoke.
This study describes the passive smoking histories of 380 never smokers who participated in a study on the respiratory health effects of tobacco smoke exposure conducted at a cancer screening clinic in Buffalo, New York, in 1986. Subjects were asked to report on their exposure to tobacco smoke during childhood years at home, as an adult at home, and as an adult at work. A total of 73 and 67% of subjects reported at least one year of continuous exposure to tobacco smoke at home as a child and as an adult, respectively. A total of 87% of subjects reported exposure to tobacco smoke at work. Subjects under age 40 years were more likely to report exposure to tobacco smoke at home as a child than were subjects aged 40 and older. Males and females differed in their reported exposure to tobacco smoke at home during adult years, with females reporting nearly twice as much exposure. Adult exposure at home also varied with age, with female subjects over age 55 years more likely to report having lived with other smokers. Age-adjusted correlations between childhood, adult home, and workplace exposure measures revealed little association between reports of exposure during different life stages. This study also evaluated concordance between subjects' exposure reports and those of surrogates who were asked to report on the subject's exposure at home, at work, and during childhood. Results showed good agreement between subjects and surrogates on most exposure measures. The results of this study underscore the need to obtain a complete exposure history from subjects when attempting to represent lifelong passive smoke exposure.
Actuarial Analysis↗
Mortality patterns among a Native American population in New York State.
This study investigated patterns of mortality among a Native American tribe, the Seneca Nation of Indians (SNI). The names of 962 tribal members reported to have died in New York State between 1955 and the end of 1984 were identified through a review of tribal roll books maintained by the Seneca Nation. Positive matches were obtained for 796 (83%) of these individuals using New York State mortality files for the period under investigation. Standardized Proportionate Mortality Ratios (PMR) were computed for major causes of death based on cause-specific mortality patterns in the New York State population for each sex during the same time period. Significantly elevated risks of mortality were observed for all infectious diseases, tuberculosis, diabetes mellitus, cirrhosis, and accidents. Depressed mortality ratios were noted for deaths due to all cancers combined, and for cancers of the lung, pancreas, breast, and lymphatic/hematopoietic cancers. Changes in mortality risks over time were also observed.
Cause of Death↗