Does cigarette smoking lead to the subsequent development of leukemia?
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Adult↗
Biomedical subjects
M S Linet
Publications and source records attributed to M S Linet.
Prior medical conditions and the risk of adult leukemia in Shanghai, People's Republic of China.
A population-based case-control interview study of 486 adult leukemia cases and 502 healthy controls was carried out in Shanghai, People's Republic of China during 1987-89 to evaluate the etiologic role of prior medical conditions, medications, and diagnostic X-rays. Risks were examined separately for 236 cases with acute non-lymphocytic leukemia (ANLL), 79 with chronic myeloid leukemia (CML), 81 with acute lymphocytic leukemia (ALL), and 21 with chronic lymphocytic leukemia (CLL). Little difference was found between cases and controls for prior history of diabetes, hypertension, allergic conditions, most medications, and diagnostic X-rays. A few significant associations were observed for appendectomy, tuberculosis, and for several other chronic disorders with specific leukemia cell types, but the odds ratio estimates for most of these ranged from two to three and, with the exception of the two specified above, were based generally on five or fewer exposed controls. In contrast to an association with childhood leukemia in Shanghai, prior use of chloramphenicol was not linked with ANLL or other forms of adult leukemia. Further research is needed to clarify the relation of specific medical conditions and exposures with particular subtypes of leukemia, and to examine reasons for the low incidence of CLL in China and other Asian populations.
Adolescent↗
Risk factors for small intestine cancer.
Small intestine cancer is relatively rare. Clinical reports have suggested that several medical conditions may predispose to increased occurrence of this cancer, but otherwise its etiology is unknown. In one of the first case-control studies of this cancer, we compared questionnaire responses provided by next-of-kin of 430 persons who died of small intestine cancer cf921 controls who died of other causes. Subjects were identified from decedents included in the 1986 United States National Mortality Followback Survey. The questionnaires sought information on demographic and lifestyle characteristics, including diet and use of tobacco and alcohol. Tobacco and alcohol consumption were unrelated to risk of small intestine cancer, but weekly or more frequent consumption of red meat and monthly or more frequent intake of salt-cured/smoked foods were associated with two- to three fold increases in risk. The findings suggest that dietary factors probably are involved in risk of small intestine cancer, but additional research in other settings is required to clarify the determinants of these rare cancers.
Adult↗
Scleroderma and malignancy: an epidemiological study.
OBJECTIVES: Although case reports and some patient series suggest an increased risk of cancer among patients with scleroderma, there are no population based studies to support this association. A population based follow up study was therefore carried out of 233 patients with scleroderma from the six-county Uppsala health care region of Sweden for the time period 1955-84. METHODS: Using the inpatient registry for the Uppsala health care region, all patients with scleroderma were identified. Their unique identification codes were then used to perform a record linkage with the National Cancer Registry. Expected cancer rates were determined using the age and gender specific rates for the Uppsala health care region. RESULTS: The standardised incidence ratio (SIR) for all cancers among these patients was significantly increased (SIR = 2.4; 95% CI = 1.5 to 3.6). The SIRs for lung cancer (SIR = 7.8; 95% CI = 2.5 to 18.2) and non-Hodgkin's lymphoma (SIR = 9.6; 95% CI = 1.1 to 34.5) were also significantly increased. Excluding patients who were diagnosed with cancer within a year of their scleroderma diagnosis resulted in similar findings, though the SIR for non-Hodgkin's lymphoma was no longer statistically significant. CONCLUSIONS: Larger population based investigations of cancer risk among patients with scleroderma are needed to confirm these initial findings and to evaluate in greater detail possible cancer risk among these patients.
Aged↗
non-Hodgkin's lymphoma and occupation in Sweden: a registry based analysis.
Incidence of non-Hodgkin's lymphoma in different employment categories was evaluated from the Swedish Cancer-Environment Registry, which links cancer incidence during 1961 to 1979 with occupational information from the 1960 census. New associations were found for men employed in shoemaking and shoe repair, porcelain and earthenware industries, education, and other white collar occupations. Several findings supported associations found in other countries, including excesses among woodworkers, furniture makers, electric power plant workers, farmers, dairy workers, lorry drivers, and other land transport workers. Risks were not increased among chemists, chemical or rubber manufacturing workers, or petrochemical refinery workers. Caution must be used in drawing causal inferences from these linked registry data because information on exposure and duration of employment is not available. Nevertheless, this study has suggested new clues to possible occupational determinants of non-Hodgkin's lymphoma.
Humans↗
A case-control and family study of Waldenstrom's macroglobulinemia.
Waldenstrom's macroglobulinemia (WM) is a rare disorder of lymphoid and plasma cells characterized by an immunoglobulin M (IgM) monoclonal gammopathy, clinical and immunopathologic similarities with other lymphoproliferative neoplasms, but the etiology of which is unknown. We undertook the first case-control study of this disorder among 65 cases, comprising 87% of all WM patients diagnosed during 1969-1983 in the greater Baltimore, Maryland area. Compared with 213 hospital controls without cancer, cases were slightly better educated, but there were otherwise no differences in sociodemographic factors, history of prior medical conditions, medication use, cigarette smoking, alcohol consumption, specific occupational exposures, employment in any particular industries or occupations, or familial cancer history. Cases were more likely than controls to have first-degree relatives with a history of pneumonia, diphtheria, rheumatic fever, and diabetes mellitus. An exploratory evaluation of immunologic profiles of first-degree relatives of 48% of families of cases revealed that relatives of two cases had asymptomatic IgM (> 750 mg/dl) monoclonal gammopathy and close to 40% of the 109 evaluated had diverse immunologic abnormalities. Larger population-based case-control studies are needed to further evaluate the suggestive evidence of immune dysfunction among families of WM cases.
Aged↗
Chemical exposure, ras oncogene activation, and acute myeloid leukemia.
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Acute Disease↗
Familial aggregation of hematopoietic malignancies and risk of non-Hodgkin's lymphoma.
Examination of risk factors that may be responsible for the increasing incidence of non-Hodgkin's lymphoma (NHL) over the past few decades would be incomplete without considering familial aggregation of hematolymphoproliferative neoplasms and the relative contributions of heredity and environment to the etiology of NHL. Reports of families with two or more NHL cases and sometimes additional members affected by other hematopoietic malignancies (multiple-case families) are summarized, as are findings from surveys and quantitative risk estimates from population-based studies of familial aggregation. The notable occurrence of various immunological abnormalities among multiple-case family members with and without NHL or related neoplasms is underscored, as is the diversity of types of other lymphoproliferative and hematopoietic malignancies among close relatives in these families. Preliminary evidence suggesting that multiple-case families may be more susceptible to certain environmental exposures is presented. An international registry of such families (particularly those identified in population-based studies) is proposed to clarify the interrelationship of genetic, familial, and environmental factors in the etiology of NHL.
Adult↗
Headaches preceded by visual aura among adolescents and young adults. A population-based survey.
Clinical descriptions of migraine preceded by visual aura often include a composite of striking and severe symptoms of several attacks in individual patients, but few studies have characterized the spectrum of such attacks. In a population-based telephone survey of 8920 Washington County, Maryland, residents 12 through 29 years old, the attack rate for visual aura headaches during the week prior to the standardized interview was 3.7% in male and 6.1% in female subjects. Among female subjects, the risk for visual aura headache with tension-type symptoms increased with age, whereas the risk for visual aura headache without tension symptoms decreased with increasing age. No clear age-related patterns were observed among male subjects for either type of aura headache. The severity of visual aura headache with and without tension symptoms increased with age among female subjects, but showed an inconsistent pattern among male subjects except for decreasing disability with increasing age. The median interval between the onset of aura symptoms and the onset of headache (aura interval) was 15 minutes in male subjects and 25 minutes in female subjects, with aura intervals longer than 60 minutes reported by 12% of male subjects and 20% of female subjects. In one of the first large population-based studies to characterize the spectrum of visual aura headache, differing age, gender, and subtype patterns were found.
Adolescent↗
Leukemia, lymphoma, and multiple myeloma following selected medical conditions.
The role of selected prior medical conditions in the etiology of hematopoietic malignancies was examined in a case-control study of members of two regional branches of the Kaiser Permanente Medical Care Program (USA). Past history of chronic infectious, autoimmune, allergic, and musculoskeletal disorders was abstracted from medical records for leukemia (n = 299), non-Hodgkin's lymphoma (NHL, n = 100), and multiple myeloma (n = 175) cases and matched controls (n = 787). Little difference was found between cases and controls for most of the chronic conditions evaluated, including sinusitis, carbuncles, urinary tract infections, pelvic infections, herpes zoster, asthma, rheumatoid arthritis, psoriasis, bursitis, and gout. Only three statistically significant elevated risks were found, i.e., with combined disc disease myeloma among patients with prior eczema and disk and other musculoskeletal conditions, and NHL following tuberculosis. Only two of these associations showed consistent patterns by sex and geographic region (myeloma with eczema and with musculoskeletal conditions). While prior history of eczema and musculoskeletal conditions may slightly increase risk of myeloma, this study provided little if any support for an association of chronic infectious, autoimmune, allergic, and musculoskeletal conditions with subsequent occurrence of the leukemias or NHL. Additionally, these data did not support a role for chronic antigenic stimulation, as defined in previous epidemiologic studies, in the etiology of hematopoietic malignancies.
Aged↗
Radiation from Chernobyl and risk of childhood leukaemia.
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Accidents↗
Chronic leukaemias.
In recent years many subtypes of CLL and some CML variants have been recognized throughout the world by means of careful clinical, epidemiological, immunological, molecular biological and viral studies. Most striking has been the establishment of a close association between certain immunophenotypical subtypes of CLL and infection with HTLV-I and possibly HTLV-II. CLL has consistently been shown to have a strong genetic component and a low incidence among Asians, but a growing body of evidence also links this major leukaemia type with environmental factors including solvents, unidentified farming and other occupational exposures. In contrast, CML is characterized by few genetic associations, relatively homogenous world-wide distribution, greater frequency in Blacks than in Whites, little evidence of viral aetiology, and evidence that exposures to ionizing radiation, benzene and possibly other chemical agents are important aetiological factors. Most studies suggest that acquired rather than genetic factors are of greater importance in the aetiology of CML, but this conclusion is somewhat difficult to reconcile with the relatively small variation in incidence rates internationally. Common to both disorders in most populations are an increasing incidence with age, male predominance, and stability of incidence, survival and mortality over the years, exclusive of improved survival of CML following allogeneic bone marrow transplantation.
Adult↗
Age- and sex-specific incidence rates of migraine with and without visual aura.
Age- and sex-specific incidence rates for the onset of migraine headache with and without preceding visual aura were estimated from a population-based telephone interview survey conducted between March 1986 and June 1987 of 10,169 randomly selected residents of Washington County, Maryland, between the ages of 12 and 29 years. A total of 392 males and 1,018 females were identified as having a history of migraine. Of these, 27% of male cases and 28% of female cases were defined as having migraine with visual aura. Among both males and females, the incidence rate for migraine with visual aura appears to have peaked as much as 3-5 years earlier than the age peak for migraine without aura. For males, the age-specific incidence for migraine with visual aura appears to have peaked on or before 5 years of age at 6.6/1,000 person-years, or possibly higher. In contrast, the highest incidence for migraine without aura occurred between 10 and 11 years of age at 10.1/1,000 person-years. New cases of migraine were uncommon among males in their late 20s. The initial onset of migraine headache begins at a later age among females than among males. For females, the highest incidence of migraine with aura occurred between 12 and 13 years of age at 14.1/1,000 person-years; the highest incidence for migraine without aura occurred between 14 and 17 years of age at 18.9/1,000 person-years. In contrast to males, new onset of migraine was relatively common among females in their late 20s.
Adolescent↗
Assessment of family history information in case-control cancer studies.
Evidence for the genetic basis of cancer has increased in recent years, and thus, assessing familial aggregation may play an important role in epidemiologic studies. To assess the degree to which family history variables are collected in cancer case-control studies, the authors conducted a literature review of studies published in six journals during 1982-1984. Only 25% of these included a family history component. The authors review some of the literature in favor of inclusion of family information and argue for its routine collection in cancer case-control studies.
Breast Neoplasms↗
Cigarette smoking and leukemia: results from the Lutheran Brotherhood Cohort Study.
In a 20-year follow-up (1966-86) of 17,633 White males who described tobacco use in a mailed questionnaire sent in 1966, there were 74 deaths from leukemia (including 30 myeloid, 30 lymphatic, and 14 other and unspecified leukemia). Among men who ever smoked cigarettes, increased risks were observed for lymphatic (relative risk [RR] = 2.7), and other and unspecified leukemia (RR = 1.5); risks rose with increasing number of cigarettes smoked, although the dose-response relationship was statistically significant only for total leukemia. Mortality from myeloid leukemia was not elevated, except among those smoking over a pack of cigarettes per day. Results from this cohort support a relationship between cigarette smoking and leukemia. Further studies are needed to elucidate subtype associations with cigarette smoking.
Adult↗
Descriptive epidemiology of childhood leukaemia.
Internationally there is a 4-fold variation in age-adjusted incidence rates for childhood leukaemia (all types combined), with only slightly greater worldwide differences specifically for acute lymphocytic leukaemia (ALL) and for acute nonlymphocytic leukaemia (ANLL). Total leukaemia rates are highest among Hispanic populations in Costa Rica and Los Angeles (males), due primarily to elevated ALL incidence, while low rates occur among US blacks, Kuwaitis, Israeli non-Jews, and Bombay Indians. In most populations the patterns for ALL are similar to those for total leukaema, with peak incidence at ages 1-4 and a decline thereafter. Lower and more uniform rates are generally observed at all ages for ANLL. Age-adjusted rates for ANLL appear to vary substantially among some populations with uniform ALL incidence rates (e.g., among Asians) and yet appear to be similar in other populations with variation in ALL rates (e.g., whites and blacks in the US). Possible variation among registries in completeness of childhood leukaemia ascertainment and accuracy of diagnosis by cell type should be assessed, while case-control investigations among populations with very high and very low rates may provide useful information about the cell-type specific determinants of childhood leukaemia.
Adolescent↗
Gender differences in the experience of headache.
Since 1940 numerous studies have shown that women report higher rates of symptoms, illness, disability and medical care utilization than men. The present analysis addresses gender differences in headache, with a focus on symptom frequency and associated pain and duration of each subject's most recent headache attack experienced within 4 weeks of interview. A random sample of 10,167 Washington County, Maryland residents (ages 12-29 years) were administered a standardized telephone interview in a large epidemiologic study of headache during 1986-87. Among the respondents, 6347 described one or more headaches occurring within 4 weeks of the interview. Women reported few specific symptoms more frequently than men, and the relative rankings of the symptoms were nearly identical for each gender (rs = 0.98). Estimated pain associated with each subject's headache and the duration of the attack were systematically greater for women than men. Although the relative rankings of symptoms by associated pain were very similar (rs = 0.90), the correlation for the ranking of symptoms for duration by gender was less strong (rs = 0.59). Women were significantly more likely to report recent headache-related disability and to seek health care services for their headaches, even after adjusting for headache severity. The results suggest that a strong interplay of an underlying physiological difference with socially determined role perceptions and illness orientations lead to greater reporting of symptoms by women.
Activities of Daily Living↗
The relationship of headache symptoms with severity and duration of attacks.
Efforts to develop clinically useful headache classification schemes have generally focused on linking specific symptom groupings with specific headache subtypes. An alternative conceptual approach, the "severity model" of headache, considers a continuum of headache ranging from mild to severe forms with specific headache subtypes distinguished by level of severity rather than unique constellations of symptoms. A population-based telephone interview was carried out among 10,169 subjects aged 12-29 to estimate the prevalence of serious headaches and better characterize symptoms that accompany headache attacks. In an analysis of frequency of occurrence, pain and duration of recent (within 4 weeks prior to interview) headache attacks, the data revealed that common symptoms (such as forehead pain and pain in the back of the head, neck and shoulders) were reported frequently, but headaches with these symptoms were generally characterized by low levels of pain and short duration. Although not an original study objective, the data were analyzed to determine whether distinct symptom constellations could be identified or whether symptoms overlapped between headache types. Symptoms of migraine were frequently experienced concomitant with tension-type symptoms; the resultant headaches were usually characterized as moderate in intensity. In contrast, symptoms usually associated with migraine in the absence of concomitant tension-type symptoms were infrequently experienced, but resulted in headaches causing the greatest disability. The data provide some support for the severity model of headache.
Adolescent↗