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N S Weiss

Publications and source records attributed to N S Weiss.

At least 37 records · Page 2Linked to original sources
PubMed2001

Risk factors for synchronous primary endometrial and ovarian cancers.

PURPOSE: The incidence of synchronous primary endometrial and ovarian cancer is 2- to 10-fold higher than that expected based on the incidence of each cancer alone. We sought to evaluate reasons for this in a case-control study. METHODS: We combined data on a maternal history of cancer and reproductive and menstrual factors from 56 women with synchronous multiple primary disease who had participated in three population-based studies of gynecologic cancer. For comparison, we analyzed the same information from 280 women with endometrial cancer alone, 280 with ovarian cancer alone, and 280 without a history of either cancer. RESULTS: The reduced risk of multiple primary disease associated with high parity (2 or more births vs 0: OR = 0.37, 95% Cl, 0.19-76) and long-term use of oral contraceptives (12 or more months vs none: OR = 0.60, 95% Cl, 0.24-1.5) tended to be more pronounced than that associated with endometrial cancer alone or with ovarian cancer alone. CONCLUSIONS: Though limited by relatively small numbers, our results suggest that the presence of some common etiologies is a basis for the unusually high co-occurrence of endometrial and ovarian cancers.

Adult↗
PubMed2001

Colorectal cancer following tamoxifen therapy for breast cancer (United States).

BACKGROUND: An analysis combining data from several clinical trials has raised concern that tamoxifen therapy may increase the risk of a subsequent colorectal malignancy. We conducted a nested case-control study to test this hypothesis. METHODS: A cohort of women diagnosed with breast cancer in 1978-1992 was identified from the western Washington population-based cancer registry. Cases included women who subsequently developed colorectal cancer prior to 1995. Controls were a random sample of the cohort who did not develop a second primary malignancy, matched to cases on age, stage, and year of initial cancer diagnosis. Tamoxifen use was ascertained by medical record abstraction and physician questionnaires. RESULTS: Thirty-six percent of the 122 cases for whom information could be obtained received tamoxifen versus 38% of 194 controls. Relative to non-users and adjusted for receipt of other therapies, there was no increased risk of colorectal cancer associated with tamoxifen use in general (matched odds ratio [mOR] = 0.9, 95% CI 0.6-1.6), longer durations of use (for > or =37 months, mOR = 0.8, 95% CI 0.4-1.9), higher cumulative doses of therapy (for > or =15 g, mOR = 0.8, 95% CI 0.4-1.6), or use that started at least 5 years prior to the end of study follow-up (mOR = 1.1, 95% CI 0.3-3.7). CONCLUSIONS: We found no overall increased risk for colorectal cancer among tamoxifen users.

Adult↗
PubMed2001

Bone mineral density and endogenous hormones and risk of breast cancer in postmenopausal women (United States).

OBJECTIVE: This case-cohort study was designed to examine whether total hip bone mineral density (BMD) is independently associated with breast cancer over and above its association with other determinants, including levels of total and bioavailable estradiol and testosterone and sex-hormone binding globulin. METHODS: Our study population was selected from a cohort of 8,203 postmenopausal women who were screened for the Fracture Intervention Trial in 1992, at which time BMD was assessed, and blood samples were obtained. A total of 109 women developed breast cancer during four years of follow-up; 173 other randomly selected women from the larger cohort were also selected. Cox proportional hazards with robust variance adjustment was used for these analyses. RESULTS: Relative to women in the lower fourth of the BMD distribution, the risk associated with being in the upper fourth was 2.6 (95% confidence interval (CI) 1.1-5.8). After adjusting for serum hormone levels, the corresponding relative risk was 2.5 (95% CI 0.9-5.2). With body mass index and number of years since menopause added to the multivariate analysis, the relative risk decreased to 1.4 (95% CI 0.5-4.0). CONCLUSIONS: BMD may not influence breast cancer risk independent of its relationship with endogenous hormones and measured covariates.

Aged↗
PubMed2001

Cervical spine injuries among submersion victims.

BACKGROUND: Submersion victims are frequently considered at high risk for cervical spine (C-spine) injury regardless of whether they sustain a traumatic injury. We hypothesized that C-spine injury is unlikely in submersion victims who do not sustain high-impact injuries. METHODS: The study was a cohort study of all people who submerged between January 1974 and July 1996 and received medical care or were seen by the medical examiner in King, Pierce, and Snohomish counties in Washington State. RESULTS: Eleven (0.5%) of 2,244 submersion victims had C-spine injuries. All 11 had submerged in open bodies of water; had clinical signs of serious injury; and had a history of diving, motorized vehicle crash, or fall from height. No C-spine injuries occurred in 880 low-impact submersions. CONCLUSION: Submersion victims are at risk for C-spine injury only if they have also sustained a traumatic injury. Routine C-spine immobilization does not appear to be warranted solely on the basis of a history of submersion.

Adolescent↗
PubMed2001

Sharing of drug preparation equipment as a risk factor for hepatitis C.

OBJECTIVES: This study investigated the sharing of drug preparation equipment as a possible route of hepatitis C virus (HCV) transmission. METHODS: HCV seroconversion was measured in a cohort of 317 injection drug users who tested negative for HCV antibody at recruitment. RESULTS: Cumulative HCV incidence was 16.7% per year. Among those who did not share syringes, HCV seroconversion was associated with sharing drug cookers and filtration cotton (adjusted risk ratio = 5.9; 95% confidence interval = 1.1, 31.7); 54% of HCV infections in injection drug users who did not share syringes were attributable to cooker/cotton sharing. CONCLUSIONS: Among injection drug users who do not share syringes, an important proportion of HCV infections may be attributed to cooker/cotton sharing.

Adolescent↗
PubMed2000

Community-based study of the transition to adulthood for adolescents with psychiatric disorder.

This longitudinal study examines the transition to adulthood in a randomly sampled, community-based cohort of adolescents. The study compares young adult outcomes of 33 adolescents with and 148 adolescents without psychiatric disorder. After adjustment for differences in age, gender, and social class, adolescents with psychiatric disorder were 13.74 times less likely to complete secondary school (95% confidence interval (CI): 4.17, 45.17), 4.07 times less likely to be employed or in college or trade school (95% CI: 1.4, 12.3), 3.13 times more likely to be involved in criminal activity (95% CI: 1.11, 8.87), and 6.46 times more likely to have gotten pregnant themselves or to have gotten someone else pregnant (95% CI: 1.75, 23.87). While adolescents with psychiatric disorder in this community-based study had outcomes that were somewhat more favorable than those of adolescents with psychiatric disorder in prior treatment-based studies, they nonetheless are at high risk of failing to meet young adult role expectations.

Adolescent↗
PubMed2000

Case-control differences in the reliability of reporting a history of induced abortion.

The authors investigated the possibility that, in interview-based case-control studies, controls are more likely than cases to underreport a history of induced abortion. A case-control study was conducted in White women under 45 years of age who had given birth in Washington State during 1984-1994. The cases were women in three metropolitan counties of Washington State diagnosed with invasive breast cancer during 1984-1994; controls were selected through random digit dialing. A history of induced abortion among study participants was compared between interview data and information collected on the birth record of the last child to whom they gave birth (225 cases, 303 controls). Among women with a prior induced abortion recorded on the birth record, 14.0% of the 43 cases and 14.9% of the 47 controls did not report an induced abortion at interview (difference = -0.9%, 95% confidence interval of the difference: -15, 14). The authors' data do not suggest that controls are more reluctant to report a history of induced abortion than are women with breast cancer.

Abortion, Induced↗
PubMed2000

Hormone replacement therapy in relation to risk of lobular and ductal breast carcinoma in middle-aged women.

BACKGROUND: In the majority of studies, long term, recent use of hormone replacement therapy has been associated with an increased risk of breast carcinoma. However, little attention has been paid to the possibility that the magnitude of this association may vary according to the histologic type of breast carcinoma. METHODS: In this population-based case-control study, interviews were conducted with 537 female residents of King County, Washington who were ages 50-64 years and who had been diagnosed with primary breast carcinoma between January 1, 1988 and June 30, 1990. Interviews with 492 randomly selected King County women without a history of breast carcinoma served as a basis for comparison. Analyses were performed separately for women with lobular and for those with ductal tumors. RESULTS: Compared with nonusers of menopausal hormones, those who currently were using combined estrogen and progestin hormone replacement therapy (CHRT) and had done so for at least 6 months had an elevated risk of lobular breast carcinoma (odds ratio [OR] = 2.6; 95% confidence interval [95% CI], 1.1-5.8), but no change in their risk of ductal breast carcinoma was noted (OR = 0.7; 95% CI, 0.5-1. 1). The OR associated with current use of unopposed estrogen for at least 6 months was 1.5 (95% CI, 0.5-3.9) for lobular tumors and 0.7 (95% CI, 0.4-1.1) for ductal tumors. Similar results were found when cases of invasive tumor were analyzed separately. CONCLUSIONS: The results of this study suggest that CHRT use increases the risk of lobular, but not ductal, breast carcinoma in middle-aged women.

Breast Neoplasms↗
PubMed2000

Volunteer bias in nonrandomized evaluations of the efficacy of needle-exchange programs.

OBJECTIVE: Nonrandomized comparisons of the incidence of HIV and hepatitis B and C between injection drug users (IDUs) who do and do not attend voluntary needle-exchange programs may be subject to bias. To explore possible sources of bias, we examined characteristics associated with voluntarily beginning or ceasing to participate in the Seattle needle exchange. METHODS: In a cohort of 2,879 IDUs, a standardized questionnaire measured characteristics present at enrollment. We examined the relation of these characteristics to the proportion of IDUs who began to use the program during the ensuing 12-month follow-up period and to the proportion of current exchangers who dropped out during that period of time. RESULTS: Of the 494 never-exchangers at baseline, 32% attended the exchange program during follow-up; those who reported sharing syringes or who were homeless at enrollment were more likely to become new exchange users (adjusted risk ratio [ARR] for becoming an exchange user = 1.8 for those who shared syringes, and ARR = 2.2 for those who were homeless). Of 1,274 current exchangers, 16% stopped using the exchange during followup, with daily injectors (ARR = 0.6) and those who reported backloading (ARR = 0.6) being relatively less likely to drop out of the exchange. CONCLUSIONS: The analysis suggests that IDUs participating in needle-exchange programs at a given point in time may include a particularly high proportion of those injectors whose pattern of drug use puts them at elevated risk of blood-borne viral infections.

Adult↗
PubMed2000

Adherence to postmenopausal hormone therapy during the year after the initial prescription: A population-based study.

OBJECTIVE: In randomized trials a higher proportion of women prescribed continuous combined hormone replacement therapy complete the full course of treatment compared with those prescribed sequential therapy. We sought to determine adherence to hormone therapy in a less-selected population. STUDY DESIGN: Women enrolled in a prepaid health plan participated in a telephone interview 12 to 15 months after newly initiating use of hormone replacement therapy. The interview elicited information on whether the women were still taking the hormones as first prescribed and reasons for switching or discontinuation. A computerized pharmacy database was used to determine initial doses, prescription renewal, and dates of switching or discontinuation. RESULTS: The proportion continuing the originally prescribed hormone regimen at 1 year was higher among continuous combined therapy users (68.9%, 62/90) than among sequential therapy users (54.4%, 62/114). Women who initiated continuous combined therapy were less likely to have switched regimens (10.0%) than were sequential users (20.2%; relative risk, 0.5; 95% confidence interval, 0.2-1.0) but only somewhat less likely to have discontinued use (21.2% vs 25.4%; relative risk, 0.7; 95% confidence interval, 0.4-1.3). Examined as a whole, women prescribed continuous combined therapy were less likely than those prescribed sequential therapy to quit or switch during the first year (relative risk, 0.6; 95% confidence interval, 0.4-1.0). CONCLUSION: Although adherence was higher among women prescribed continuous combined hormone replacement therapy than sequential therapy, the high level of nonadherence in both groups suggests room for improvement of menopausal therapies so that women find them acceptable for sustained use.

Aged↗
PubMed2000

Colorectal cancer incidence in Asian migrants to the United States and their descendants.

OBJECTIVES: To examine the incidence of colorectal cancer among Asian residents of the United States according to country of birth. METHODS: We determined the incidence of colorectal cancer during 1973-1986 among Asian residents in three areas of the western United States (Hawaii, San Francisco/Oakland SMSA, and western Washington state) in relation to country of birth. Numerators for the rates were obtained from the Surveillance, Epidemiology and End Results (SEER) program; a special tabulation of the 1980 US Census was used to estimate the size and composition of the population at risk. RESULTS: US-born Japanese men experienced incidence rates of colorectal cancer twice as high as foreign-born Japanese men and about 60% higher than those of US-born white men. Incidence among US-born Japanese women was about 40% higher than that among Japanese women born in Japan or US-born white women. Foreign-born Chinese men had about the same incidence of colorectal cancer as US-born white men, while US-born Chinese men experienced slightly reduced rates. Chinese women had rates that were generally 30-40% lower than that of US-born white women, regardless of place of birth. Incidence rates for both US-born and foreign-born Filipinos were 20-50% those of US-born whites. CONCLUSIONS: These findings suggest that one or more exposures or characteristics that differ between Japanese migrants and their descendants affect the development of colorectal cancer.

Adult↗
PubMed2000

Increased risk of hip fracture among patients with end-stage renal disease.

BACKGROUND: Although patients with end-stage renal disease (ESRD) are at increased risk for bone loss, the risk of hip fracture in this population is not known. We compared the risk of hip fracture among dialysis patients with the general population. METHODS: We used data from the United States Renal Data System (USRDS) to identify all new Caucasian dialysis patients who began dialysis between January 1, 1989, and December 31, 1996. All hip fractures occurring during this time period were ascertained. The observed number of hip fractures was compared with the expected number based on the experience of residents of Olmstead County (MN, USA). Standardized incidence ratios were calculated as the ratio between observed and expected. The risk attributable to ESRD was calculated as the difference between the observed and expected rate of hip fracture per 1000 person-years. RESULTS: The number of dialysis patients was 326,464 (55.9% male and 44.1% female). There were 6542 hip fractures observed during the follow-up period of 643, 831 patient years. The overall incidence of hip fracture was 7.45 per 1000 person years for males and 13.63 per 1000 person years for females. The overall relative risk for hip fracture was 4.44 (95% CI, 4.16 to 4.75) for male dialysis patients and 4.40 (95% CI, 4.17 to 4.64) for female dialysis patients compared with people of the same sex in the general population. While the age-specific relative risk of hip fracture was highest in the youngest age groups, the added risks of fracture associated with dialysis rose steadily with increasing age. The relative risk of hip fracture increased as time since first dialysis increased. CONCLUSIONS: The overall risk of hip fracture among Caucasian patients with ESRD is considerably higher than in the general population, independent of age and gender.

Age Distribution↗
PubMed2000

Continuous combined hormone replacement therapy and risk of endometrial cancer.

OBJECTIVE: Postmenopausal women who receive sequential hormone replacement therapy with estrogen combined with progestogen for 10 to 24 d/mo for a prolonged period may have an elevated endometrial cancer risk relative to those who have never received hormone replacement therapy. We investigated whether daily use of estrogen and progestogen (continuous combined hormone replacement therapy) could diminish any excess endometrial cancer risk. STUDY DESIGN: A population-based study in Washington State obtained interview data from 969 women aged 45 to 74 years with endometrial cancer diagnosed during 1985 through 1991 or 1994 through 1995 and from 1325 age-matched control subjects selected primarily by random digit dialing. Women who had received only continuous combined hormone replacement therapy were compared with women who had only received another hormone replacement therapy regimen or who had never received hormone replacement therapy. RESULTS: The risk of endometrial cancer among users of continuous combined hormone replacement therapy (n = 9 case patients, n = 33 control subjects) relative to women who had never received hormone replacement therapy was 0.6 (95% confidence interval, 0.3-1.3); the risk relative to women who received hormone replacement that included progestogen for 10 to 24 d/mo was 0.4 (95% confidence interval, 0.2-1.1). Most continuous combined hormone replacement therapy use was short-term (<72 months) or recent (in the previous 24 months). CONCLUSION: Women who had received continuous combined hormone replacement therapy for several years did not appear to be at any increased risk for endometrial cancer relative to women who had never received hormone replacement therapy and may in fact be at decreased risk for endometrial cancer.

Aged↗
PubMed2000

Fetal antigen hypothesis and ovarian cancer: is there an immunogenic explanation for the reduction in risk associated with parity?

The hypothesis that a woman's immunologic response to fetal antigens arising from paternal genes may explain some of the reduction in risk of ovarian cancer associated with parity has not, to our knowledge, been examined. We analyzed data from a case-control study to evaluate the risk of epithelial ovarian cancer among women of similar parity associated with proposed indices of paternally derived fetal antigen exposure. Cases included white women 20-79 years of age diagnosed with epithelial ovarian cancer in three counties in Washington State between January 1, 1986, and December 31, 1988 (N = 322). Controls (N = 426) were selected by random-digit dialing and were broadly similar to cases in age and county of residence. After excluding women who had fewer than two pregnancies (or, in some analyses, fewer than two livebirths) and adjusting for age and number of livebirths, we observed no reduction in risk associated with number of marriages or number of partners with whom a study participant conceived a pregnancy and/or had a child. Nevertheless, these relatively crude indices of exposure to paternally derived fetal antigens do not preclude the possibility that a woman's response to other fetal or pregnancy-related antigens may antagonize the development of ovarian cancer.

Adult↗
PubMed2000

Induced abortion in relation to breast cancer among parous women: a birth certificate registry study.

We wished to assess the relation of induced abortion to the subsequent incidence of breast cancer among parous women, using a design that would prevent the possibility of differentially complete reporting of abortion history by women with breast cancer and controls. Our study was conducted within a cohort of women who gave birth to a child during 1984-1994 while residing in 13 counties of western Washington. Cases were women from the cohort diagnosed with breast cancer between 1984 and 1994. From the remaining cohort members, five controls were matched to each woman with breast cancer by year of index birth (ie, the last child born before breast cancer diagnosis) and by age at delivery. We categorized 463 cases and 2,201 controls according to history of induced abortion as recorded on the index birth certificate. The risk of breast cancer was not found to be associated with a prior induced abortion (estimated relative risk (RR) = 0.9, 95% confidence interval (CI) 0.7-1.2). These results suggest that an induced abortion, if followed at some later time by pregnancy and childbirth, does not increase a woman's risk of breast cancer.

Abortion, Induced↗