Biomedical subjects
Publications and source records attributed to R C Brownson.
The authors discuss the major findings of a survey intended to supply information to the Missouri Arthritis Program in order to reach its goal of improving the health status and quality of life of arthritis patients.
The authors discuss the magnitude of cardiovascular disease in terms of mortality and medical care, while showing that significant proportions of Missourians are at risk of developing cardiovascular disease.
The discrepancy between black and white cancer mortality rates remains a cause of concern for the public health community. The authors discuss some of the factors that contribute to the problem and suggest that an organized local, state and national effort is necessary to find a solution.
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A series of case-control studies was conducted to investigate cancer risks among farmers. These studies were based on Missouri Cancer Registry data for 15,000 white male patients, including 1720 subjects classified as farmers, registered between 1984 and 1988. For each cancer site, all other cancer registrations formed the control group. The largest risks among farmers were found for lip cancer (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.99 to 4.73) and cancer of the bone (OR, 2.02; 95% CI, 0.66 to 5.81). Elevated risks were observed for several other sites, including the nasal cavity and sinuses (OR, 1.66; 95% CI, 0.54 to 4.70), prostate (OR, 1.33; 95% CI, 1.18 to 1.51), non-Hodgkin's lymphoma (OR, 1.40; 95% CI, 1.04 to 1.85), and multiple myeloma (OR, 1.40; 95% CI, 0.87 to 2.24). Other smaller elevations in risk were noticed for cancer of the rectum (OR, 1.21; 95% CI, 0.95 to 1.53), liver (OR, 1.19; 95% CI, 0.58 to 2.37), malignant melanoma (OR, 1.26; 95% CI, 0.63 to 2.45), kidney (OR, 1.21; 95% CI, 0.89 to 1.65), and leukemia (OR, 1.12; 95% CI, 0.81 to 1.55); however, some of these estimates were imprecise due to small numbers. The overall OR for lymphatic and hematopoietic cancers was 1.28 (95% CI, 1.06 to 1.56). Consistent with previous studies, a decreased risk of lung cancer was observed among farmers (OR, 0.67; 95% CI, 0.60 to 0.76). The current findings are presented in the context of other recent studies, including discussions of possible causes of farming-associated excess cancer risk and possible sources of bias.
A case-control study of lung cancer was conducted to evaluate the relationship between lung cancer histologic types and occupation, adjusted for smoking. A total of 4,431 white male cases and 11,326 cancer controls, diagnosed between 1980 and 1985, were identified through the Missouri Cancer Registry. For all histologic types combined, excess risk was observed among many a priori suspected high-risk occupations. Lung cancer was elevated among men employed as insulators (odds ratio [OR] = 6.0; 95% confidence interval [CI] = 0.7, 137.8), carpenters (OR = 1.3; 95% CI = 1.0, 1.7), painters, plasterers, and wallpaper hangers (OR = 2.0; 95% CI = 1.2,3.3), structural metal workers (OR = 1.9; 95% CI = 0.6,6.0), mechanics and repairers (OR = 1.3; 95% CI = 1.0,1.7), motor vehicle drivers (OR = 1.5; 95% CI = 1.2,1.8), police and firefighters (OR = 1.6; 95% CI = 1.1,2.3), and food service personnel (OR = 1.8; 95% CI = 1.0,3.5). A deficit of lung cancer was observed among farmers (OR = 0.9; 95% CI = 0.7,1.0). Adenocarcinoma of the lung was elevated among carpenters (OR = 1.6; 95% CI = 1.0,2.5) and cabinet and furniture makers (OR = 2.0; 95% CI = 0.4,8.1), which is interesting because of the previous reports of excess adenocarcinoma of the nasal cavity associated with wood dust exposure. Adenocarcinomas were also elevated among plumbers (OR = 2.0; 95% CI = 1.0,3.8) and printers (OR = 1.8; 95% CI = 0.7,4.2). Electricians were at slightly increased risk for adenocarcinoma (OR = 1.5; 95% CI = 0.7,2.8) and "other" or mixed cell types of lung cancer (OR = 1.5; 95% CI = 0.8,2.9) but at decreased risk for small cell (OR = 0.8; 95% CI = 0.3,2.0) and squamous cell (OR = 0.8; 95% CI = 0.4,1.6) tumors. Among welders, adenocarcinoma (OR = 1.7; 95% CI = 0.7,3.8) and squamous cell (OR = 1.7; 95% CI = 0.9,3.3) cancers were elevated, but small cell and "other" lung cancers were not. Despite the limitations of the Cancer Registry data, some interesting associations were observed that merit further study, particularly the association between lung adenocarcinoma and occupational exposure to wood and wood dust.
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A case-control study of uterine cervical cancer was conducted using 331 cases and 993 age-matched controls identified through the Missouri Cancer Registry during 1984-1986. Patients with smoking- or alcohol-related cancers were excluded from the control series. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (Cls) after adjustment for age, cigarette smoking, alcohol consumption, and stage at diagnosis. A dose-response relation was observed between intensity of cigarette smoking and invasive cervical cancer, with light and heavy smokers having elevated risks (OR = 2.2, 95% Cl = 1.4-3.6 and OR = 3.9, 95% Cl = 2.7-5.6, respectively). Former smokers had less elevated risk (OR = 1.7, 95% Cl = 1.0-2.9), a finding consistent with a greater effect of tobacco smoke on late-stage carcinogenesis. Similar results were obtained in age- and control site-specific analyses. Further, the age-specific data suggested a dose-response relation between duration of smoking and invasive cervical cancer. An association between alcohol consumption and invasive cervical cancer was not observed.
Sources of readily available data for cancer surveillance are frequently sought. To assess the validity of information on cancer risk factors that is routinely collected in conjunction with cancer incidence reporting, the authors completed interviews for 441 patients identified through the Missouri Cancer Registry from June 1986 to May 1987. Interviews elicited information on employment history, smoking, and alcohol consumption. Data collected from interviews were compared with those previously reported to the Registry by participating hospitals. Exact agreements of three-digit US Census codes were 70% for occupation and 72% for industry. Concordance for never- versus ever-smoking status was 83%, and a high correlation (r = 0.93) was observed for level of smoking. Agreement on alcohol consumption was lower (65%), largely because of the presence of false negatives. Misclassification occurred in a random manner for occupational variables; however, differential misclassification was present for smoking and alcohol histories. Despite the limitations of registry-collected data, these findings suggest that cancer registries that obtain information on cancer risk factors may be suitable for exploratory studies, especially those involving occupational cancer surveillance.
A case-control study was conducted to investigate occupational risks for colon cancer. The Missouri Cancer Registry was used to identify a total of 1,993 white male cases and 9,965 age-matched cancer controls diagnosed between 1984 and 1987. Effect estimates were calculated for specific occupations and industries and for three levels of occupational physical activity. Odds ratios (ORs) and 95% confidence intervals (Cls) were also calculated according to anatomic subsite of colon cancer. Elevated risks were identified for workers in several occupations and industries including printing machine operators (OR = 1.9, 95% Cl 1.0-3.3), workers in food manufacturing (OR = 1.6, 95% Cl 1.2-2.2), communications workers (OR = 1.8, 95% Cl 1.0-3.3), and workers employed in the petroleum product trade (OR = 2.7, 95% Cl 1.0-7.2). Previous findings of excess risk among selected occupations of higher socioeconomic status were confirmed. Analyses by anatomic subsite showed that excess risk for an occupational group was usually confined to a single subsite, which suggests some specificity of effect. For example, elevated risk among males employed in manufacturing-related industries was shown primarily for cancer of the cecum. The findings by level of occupational physical activity corroborated recent reports of increased colon cancer risk associated with employment in sedentary occupations. Excess risk (OR = 1.4, 95% Cl 1.0-1.9) was shown among males employed in sedentary jobs and an inverse linear trend in risk was shown according to level of occupational physical activity. Risk associated with sedentary occupations was highest for cancer of the cecum (OR = 2.1, 95% Cl 1.1-4.0). Despite the limitations of the cancer registry-collected data, some associations were observed that deserve further study.
During the past decade, the incidence of breast cancer in Missouri women has apparently increased. As this study shows, however, this apparent rise is due to the early detection of localized cancers--those with higher cure rates. The implications of the findings are discussed.
A number of cancer control efforts, while proven to be effective, require significant support from state and local lawmakers in order to be successful. This survey of state legislators' attitudes toward health risks and risk reduction measures that could be undertaken shows a favorable outlook for cancer control programs in Missouri.
Mortality and incidence studies have suggested that agricultural workers may be at increased risk for some cancers. Case-control methods were used to investigate the relationship between farming, other occupations, and lymphoma, multiple myeloma, and leukaemia. A total of 475 male cases, aged 20 years or more, and 1425 age-matched controls were identified through the Missouri Cancer Registry for the years 1984-1985. People with smoking-related cancers were excluded as controls to minimize bias associated with farmers' reported smoking patterns. Farmers had slightly elevated risks for non-Hodgkin's lymphoma (odds ratio (OR) = 1.11) and Hodgkin's disease (OR = 1.30). The risk for leukaemia (all types) was not elevated (OR = 0.91); however, for acute lymphatic leukaemia an OR of 2.84 was detected. An OR of 2.78 (95% confidence interval = 1.09-7.07) for reticulosarcoma was observed among farmers 65 years and older. Several other occupational associations were noted which have been reported previously. Carpenters (OR = 3.10) and machinists (OR = 4.85) were at increased risk for Hodgkin's disease. An elevated risk of leukaemia was observed for mechanics (OR = 4.79). Since most previous studies of the associations between lymphatic and haematopoietic cancers and agriculture have been based on mortality data, additional studies of incident cases are suggested.
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To provide additional data on the smoking-breast cancer association, a case-control study of 456 cases of breast cancer and 1693 matched controls was conducted among participants in a cancer screening program. The adjusted risk of breast cancer for current smokers was 1.38 (95% confidence interval, 1.01 to 1.90). Analysis of smoking habits restricted to premenopausal women revealed a risk estimate of 2.33 (confidence interval, 1.10 to 4.96) among current smokers and increasing linear trends in risk for number of cigarettes smoked per day and for number of years of smoking. Although smokers had an earlier natural menopause than nonsmokers, there was no evidence of a protective effect of early menopause after adjustment for other factors. These findings suggest that smoking may increase the incidence of breast cancer, especially in premenopausal women.
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Previous studies have suggested that certain occupational groups may be at increased risk for prostate cancer. A cancer registry-based case-control study was conducted to investigate possible associations between various occupations and the risk of prostate cancer among 1,239 case subjects and 3,717 age-matched control subjects. Elevated relative risk estimates were observed for farmers, mechanics, sheet metal workers, separating machine operators, and for men employed in several manufacturing industries. These findings are discussed in the context of previous studies, and suggestions for future research are provided.
The relation between various risk factors and adenocarcinoma of the lung was evaluated in a case-control study. Subjects were selected from the Colorado Central Cancer Registry from 1979-1982 in the Denver metropolitan area. A total of 102 (50 males and 52 females) adenocarcinoma case interviews and 131 (65 males and 66 females) control interviews were completed. The control group consisted of persons with cancers of the colon and bone marrow. The risk estimates associated with cigarette smoking were significantly elevated among males (odds ratio (OR) = 4.49) and females (OR = 3.95) and were found to increase significantly (p less than 0.01) with increasing levels of cigarette smoking for both males and females. For adenocarcinoma in females, the age- and smoking-adjusted odds ratios at different levels of passive smoke exposure followed an increasing overall trend (p = 0.05). After additional adjustment for potential confounders, prior cigarette use remained the most significant predictor of risk of adenocarcinoma among males and females. Analysis restricted to nonsmoking females revealed a risk of adenocarcinoma of 1.68 (95% confidence interval (Cl) = 0.39-2.97) for passive smoke exposure of four or more hours per day. Neither sex showed significantly elevated risk for occupational exposures, although males bordered on significance (OR = 2.23, 95% Cl = 0.97-5.12). The results suggest the need to develop cell type-specific etiologic hypotheses.