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Biomedical subjects

M R Spitz

Publications and source records attributed to M R Spitz.

At least 145 records · Page 8Linked to original sources
PubMed1990

Early cancer detection: update for primary-care physicians.

This article highlights information about the importance of early detection of cancer in the primary care physician's office. It represents information derived from a cancer prevention reference manual, ReCap: Recommendations for Cancer Prevention, developed by the Department of Cancer Prevention and Control at The University of Texas M.D. Anderson Cancer Center. Production, evaluation, and distribution to all primary care physicians in Texas were funded by the Physician Oncology Education Program, a program of the Texas Medical Association funded by the Texas Cancer Council.

Female↗
PubMed1989

Chromosome sensitivity to bleomycin-induced mutagenesis, an independent risk factor for upper aerodigestive tract cancers.

Defective DNA repair capability, measured by enumerating mutagen-induced chromosomal lesions, might explain variable host susceptibility to the action of environmental carcinogens. We compared sensitivity to bleomycin-induced chromosome damage in 75 patients (53 men and 22 women) with previously untreated upper aerodigestive tract malignancies with that in 62 healthy control subjects. Data on tobacco and alcohol use were derived from a detailed, self-administered cancer risk factor questionnaire. Forty-five patients and 13 controls were sensitive to bleomycin-induced mutagenesis (average breaks/cell greater than 0.8). Differential susceptibility was detected in patients categorized by primary tumor location. Odds ratios for chromosome sensitivity were significantly elevated for all sites (odds ratio = 10.3 for pharyngeal cancers, 8.0 for laryngeal cancers, and 3.8 for oral cavity cancers). On logistic regression analysis, chromosome sensitivity remained a strong and independent risk factor after adjustment for potential confounding from age, sex, and tobacco and alcohol use (odds ratio = 4.3, 95% confidence limits = 2.0, 10.2). Despite the small study size and design constraints, the strength of the association with chromosome sensitivity even after adjustment for potential confounders is impressive and suggests a promising avenue for further research. The preventive implications of a valid marker for carcinogen sensitivity are manifold.

Alcohol Drinking↗
PubMed1989

Multiple primary cancer in patients with cancer of the head and neck: second cancer of the head and neck, esophagus, and lung.

Squamous cell carcinoma of the head and neck is complicated by a second primary carcinoma of the head and neck, esophagus (the upper aerodigestive tract, or UADT), or lung in 10-40% of patients. Routine panendoscopy will identify a simultaneous second primary in 9-14% of the patients. Metachronous second cancers most often involve the esophagus or lung, whereas synchronous second cancers are more common in the head and neck as occult lesions. For the highest-risk subgroups, second primary cancers occur in 4% of patients per year. In cancer of the floor of the mouth the excess mortality rate is 5-6% per year. Risk is independent of stage of the first primary and the survival impact is the greatest in groups of patients with early-stage disease. Head and neck cancer almost always results from the heavy use of tobacco for many years, either with or without the concomitant heavy use of alcohol, and these same agents are directly responsible for the second cancers of the UADT and lung. All head and neck cancer patients should be advised to avoid these agents. The clinician must diagnose and treat second cancers to extend the survival of patients with a good prognosis for control of the initial head and neck cancer. We need further progress in eliminating the use of known carcinogens in these patients, paradigms for cost-effective diagnosis and treatment of second primary cancers, effective treatment of the head and neck primary cancer devoid of long-lasting tissue toxicities, effective chemopreventive agents to retard established processes of carcinogenesis that place the patient at continued risk after cigarette and alcohol use has been eliminated, and continued efforts to control the medical illnesses to which these patients are susceptible.

Carcinoma, Squamous Cell↗
PubMed1989

Childhood nervous system tumours: an assessment of risk associated with paternal occupations involving use, repair or manufacture of electrical and electronic equipment.

Parental occupational exposures to chemical carcinogens have been associated with malignancies in offspring. Recent studies have raised the issue that electromagnetic fields may play a role in carcinogenesis. We conducted a population-based case-control study testing for an association between the occurrence of a nervous system tumour in a child and paternal employment at the time of the child's birth in occupations involving potential exposure to low frequency electromagnetic fields, primarily in the electrical and electronics industries. Birth certificate data, including parental occupation information, of 499 children who died in Texas from intracranial and spinal cord tumours were compared with 998 controls randomly selected from Texas livebirths. The odds ratio for paternal employment in industries involving potential electromagnetic field exposure was 1.6 (p less than 0.07). A risk of 3.5 (p less than 0.05) was detected for fathers who were electricians. The additional presence of chemical exposures in these diverse occupations and industries must also be considered.

Case-Control Studies↗
PubMed1989

Season-of-birth and acute leukemia of infancy.

Because of its short and clearly delineated latency period, acute leukemia of infancy is particularly suited to etiologic analysis. From 1950 to mid-1985, 31 infants with acute leukemia (less than 1 year of age) were registered at the University of Texas, M.D. Anderson Cancer Center at Houston. The medical records of these infants were reviewed for demographic and birth information. Of the 31 infants, 14 (45%) were Hispanic. The sex ratio was 3:1 male/female) for white infants and 5:9 for Hispanic infants. Of the white infants, half had acute lymphocytic leukemia, compared with all but one of the Hispanic infants. There was a significant excess of winter births among the infants diagnosed with acute leukemia (P less than 0.05). The significant association between season-of-birth and the occurrence of leukemia cases is suggestive of periodicity of an environmental etiologic agent, perhaps acting in concert with endogenous rhythmicities in susceptibility to that agent. This finding is deserving of further study.

Acute Disease↗
PubMed1989

Cancer and age.

Age is the greatest risk factor for the development of cancer. For etiologic purposes, newly diagnosed cases of cancer among a defined population during a specified time (incidence) is the usual way of depicting cancer as it relates to age. Exposure to carcinogens in utero or perinatally can produce cancers soon after birth or years later. Cancers in older children have been related to growth factors and/or a single exposure to high doses of radiation. Hodgkin's disease occurring among young adults is different histologically, clinically, and prognostically than Hodgkin's disease among older adults. For the disease among young adults, the hypothesis is that clinical disease reflects the rare consequences of a prevalent infection of low pathogenicity; age of infection is determined by socioeconomic status. In older adults, it more closely resembles the lymphomas. This suggests dynamic trends associated with changing social environments related to etiologic factors. Among adults, the steady increase in colon cancer among both genders represents constant exposure to a carcinogen(s) starting in early life and persisting throughout older ages. Breast cancer is divided into pre- and postmenopausal phases on the basis of its age distribution. International differences in postmenopausal breast cancer suggest environmental factors in postmenopausal women and genetic and hormonal factors in premenopausal women. The age distribution of lung cancer increases linearly with the amount of cigarettes smoked and there is no indication of a threshold below which cigarette smoke is safe. The downturn among the oldest age groups results from competing causes of death or reflects a cohort effect of different exposure over time. Further, the pattern of lung cancer suggests exposure to a carcinogenic agent including substances that act principally as promoters.

Adolescent↗
PubMed1989

Encouraging trends in lung cancer mortality in Texas, 1970 to 1986.

Trends in lung cancer mortality among white and black men and women in Texas for the years 1970 to 1986 offer some measure of optimism. A decline in mortality for men and women aged 35 to 44 years and for men aged 45 to 54 years is now evident. However, the rates in older men and women continue to rise. Following a long trend of ascending death rates, a plateau in the overall age-adjusted death rates among white men is now suggested. A similar decline for women will probably not be evident until early in the next century. These patterns are consistent with profound changes that have occurred in the prevalence of cigarette smoking over the past 30 years. It is urgent to maintain the momentum by emphasizing smoking cessation and prevention programs.

Adult↗
PubMed1988

Ethnic patterns of thyroid cancer incidence in the United States, 1973-1981.

Descriptive epidemiological findings for 7,696 patients with newly diagnosed thyroid cancer reported to the Surveillance, Epidemiology, and End Results (SEER) program for the years 1973 through 1981 are summarized. The preponderance of this tumor in women and of the papillary histologic subtype are well documented. The data suggest that previously reported increases in the incidence of thyroid cancer among Whites levelled off in the late 1970s. Differences in the incidence of this cancer according to ethnic group were particularly striking. Compared with White men and women, Puerto Rico Hispanics and Blacks had significantly lower thyroid cancer rates (weighted rate ratios ranged from 0.48 to 0.65). New Mexico Hispanic men and Chinese, Japanese, Hawaiian and Filipino men and women had significantly higher rates (weighted rate ratios ranged from 1.56 to 3.17). Elevated thyroid cancer rates for residents of Hawaii, regardless of ethnic group, were also a noteworthy finding. Variations in thyroid cancer risk according to ethnic group and geographical residence may reflect socio-economic or local environmental influences, including the possibility of a carcinogenic agent in volcanic lava.

Adolescent↗
PubMed1988

Squamous cell carcinoma of the upper aerodigestive tract. A case comparison analysis.

Although the etiologic importance of tobacco in risk of upper aerodigestive malignancies is unquestioned, quantification of subsite-specific risks is less well delineated. Risk estimates from this case-control study are derived from self-administered comprehensive risk factor questionnaires distributed to newly registered patients at The University of Texas M.D. Anderson Hospital and Tumor Institute, Houston. Cases included 185 white patients with histologically confirmed squamous cell carcinoma of the upper aerodigestive tract. An equal number of age-frequency and sex-frequency matched patients was randomly selected from the same patient population excluding only patients with diagnoses of squamous cell carcinoma of any site. A statistically significant dose-response relationship for three categories of cigarette pack-years was evident for both males (odds ratios [OR] = 1.8, 4.0, and 7.5) and females (OR = 1.5, 9.0, and 12.0). Highest risks were documented for laryngeal cancer (OR = 15.1) and lingual cancer (OR = 14.5). There was interaction between alcohol use and smoking among men, but no independent effect of alcohol consumption among either gender. After 15 years of smoking abstinence, males no longer exhibited increased risk (OR = 1.0) whereas the risk for females after 15 years of cessation was 1.5. There were also significantly increased risks among men associated with snuff dipping, cigar, and pipe use (OR = 3.4, 2.8, and 1.8, respectively). The differences in the magnitude of the risk estimates and dose-response curves by subsite and by sex suggest a variable susceptibility to carcinogenic action.

Adult↗
PubMed1988

Profiles of cigarette smoking among patients in a cancer center.

Although cancer patients who continue to smoke are at high risk for subsequent malignancies, especially in tobacco-exposed tissues, they are rarely the target of intervention strategies. We present smoking behavior profiles on 2,531 adult patients registered at The University of Texas M.D. Anderson Cancer Center over a 15-month period. The data are derived from self-administered risk-factor questionnaires. Prevalence data are compared with 1985 data from the National Center for Health Statistics. Percentages of current smokers were similar for men (34.6%) and women (31.8%) and comparable with national survey data. Black men had the highest percentage of current smokers (41%), while Hispanic and black females had the lowest (26.1% and 26.7%, respectively). There were proportionately fewer quitters among women compared with men (19.1% v 37.8%) and among black men and women (20.5% and 11.5%, respectively) compared with whites and Hispanics. Fifty-five percent of male patients smoked over 25 cigarettes daily, compared with 33% of men in the national data. The comparable estimates for women were 31% and 21%. While there was a clear inverse association between educational attainment and smoking prevalence, those college-educated men who did smoke were heavier smokers than their less-educated counterparts. These data highlight the importance of tailoring educational programs to correspond with the specific smoking and demographic characteristics of the patient population.

Adaptation, Psychological↗
PubMed1988

Nitrite inhalants: historical perspective.

There are important reasons for considering nitrite inhalation as a factor in the development of AIDS-related KS in young male homosexuals. These are (1) the pharmacologic properties of amyl, butyl, and isobutyl nitrites, which are toxic; (2) the mutagenic, teratogenic, and carcinogenic products resulting from metabolism of N-nitroso compounds; (3) the potent carcinogenicity of N-nitroso compounds in 39 different animal species; and (4) the deleterious effects of volatile nitrites on human lymphocytes both in vitro and in vivo. Specifically related to this epidemic, there are additional reasons for pursuing the connection between nitrite inhalation and development of KS. These include: (1) the timing of the production and sales of volatile nitrites for use as recreational drugs and the subsequent outbreak of the AIDS epidemic (7 to 10 years); (2) the extensive use of nitrites among male homosexuals; (3) the virtual universal history of nitrite use by young male homosexuals in whom KS has developed during the past 3 years; and (4) the age group in which KS is developing is consistent with a cohort initially exposed 7 to 10 years ago.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Pelvic adhesions in intrauterine device users.

A thorough inspection of the pelvis for adhesions was made at the time of laparoscopic tubal sterilization in 2131 patients. Contraceptive use was then compared in women with adhesions (cases) and those without adhesions (controls). Current or previous intrauterine device (IUD) use was not associated with a statistically significant increased incidence of adhesions (odds ratio = 0.98, 95% confidence limits 0.58-1.64). This risk was reduced to 0.62 for current IUD users. The IUDs removed at the time of laparoscopy included the Lippes Loop, Copper 7, and the Saf-T-Coil. These findings support the use of the IUD in the appropriate patient by demonstrating no increased risk for the development of adhesions in multiparous IUD users.

Adult↗
PubMed1987

Subfertility: an etiologic factor in development of testicular cancer?

Gonadal dysfunction with resultant subfertility has been implicated as a possible etiologic factor in testicular cancer. A survey of 57 men who had been married before testicular cancer developed revealed that only four marriages (9%) had problems with fertility. Our findings fail to support a premise that testicular carcinoma is associated with prior male infertility.

Adult↗
PubMed1987

Childhood nervous system tumors--an evaluation of the association with paternal occupational exposure to hydrocarbons.

Paternal occupational exposures to hydrocarbons have been associated with childhood nervous system cancer, but study results have not been consistent. This population-based case-control study was designed to examine this association using a large sample size to increase the precision of risk estimates. The birth certificates of 499 children who died in Texas from intracranial and spinal cord tumors were compared with 998 control certificates randomly selected from all Texas live births. Information on parental job title and industry at the time of birth was obtained from the birth certificates. No significant associations were identified for the dichotomized variable of all hydrocarbon-related occupations combined, as variously defined in previous studies, or for most of the specific jobs affiliated with exposures to hydrocarbons. Significant, relatively stable odds ratios (OR) were found for printers and graphics arts workers (OR = 4.5; 95% confidence interval (CI) = 1.4-14.7) and chemical and petroleum workers with high exposure levels (OR = 3.0; CI = 1.1-8.5). A discussion of the biases involved in this type of study design is presented.

Adolescent↗