Search PubMed⌕ Search

Biomedical subjects

R Doll

Publications and source records attributed to R Doll.

At least 181 records · Page 10Linked to original sources
PubMed1983

International variations and temporal trends in mortality from multiple myeloma.

Mortality statistics for multiple myeloma over the period 1960-1975 have been analysed for 23 countries. Attention has been focused on international variations, secular trends, and the male to female mortality ratio. The greatest percentage increases have been found in countries with low overall rates. The male:female ratio was generally higher in countries with high rates, and the national rates correlated more strongly with GNP per caput than with an index of medical care (hospital beds/10,000). Further analyses have been carried out over the period 1955-79 in Sweden, a country with high but relatively stable rates, and Japan, where the rates are very low but are increasing rapidly. An age, period, and cohort analysis of the trends in these countries is presented and criticized. The contributions made by increased diagnostic capability and by an increase in the true incidence of the disease are discussed.

Adult↗
PubMed1983

Trends in mortality from carcinoma of the liver and the use of oral contraceptives.

There is increasing concern that contraceptive pill usage may increase the risk of hepatocellular carcinoma. As primary malignant liver cancer is very rare in this country, any effect due to oral contraceptives should be apparent in national mortality statistics. An analysis of mortality rates over the last 24 years shows a small but consistent increase for young women starting to occur during the end of the last decade. However no such trend is apparent in data from other countries where pill usage is comparable to that in the U.K. Overall liver cancer remains an extremely uncommon cause of death in developed countries, but it will be particularly important to monitor trends in this disease in the future.

Adult↗
PubMed1983

Genital warts and cervical neoplasia: an epidemiological study.

Cervical carcinoma and cervical intra-epithelial neoplasia (CIN) are likely to be associated with all sexually transmitted diseases (STDs). To help discover which (if any) of the recognised STDs might actually cause these conditions, a key question is whether one particular such association is much stronger than the others. The present study is therefore only of women newly attending an STD clinic, and compares the prevalences of cytological abnormalities of the cervix among 415 women attending with genital warts, 135 with genital herpes, and 458 with trichomoniasis or gonorrhoea. Significantly more genital wart patients (8.1%) than trichomoniasis or gonorrhoea patients (1.9%) showed dyskaryotic changes (adjusted relative risk (RR) = 5.8 with 95% limits 2.5-13.5) at, or a few months before, first attendance, while no excess whatever was seen in women with genital herpes. Moreover, half the women had a subsequent smear (at an average of 3-4 years after first attendance) and, although the diagnosis at first attendance was not related to the onset rate of dyskaryotic changes observed in these subsequent smears, it was related to the onset rate of grade III cervical intra-epithelial neoplasia (CIN III), which was found in 7 previous genital wart patients, in 2 previous trichomonas patients, but in 0 previous genital herpes patients. Thus, our findings suggest that herpes is not directly relevant to dyskaryotic change, but that one or more of the human papilloma viruses that cause genital warts may be.

Adult↗
PubMed1983

Oral contraceptives and breast cancer: final report of an epidemiological study.

During 1968-1980, 1176 women aged 16-50 years with newly diagnosed breast cancer and a like number of matched controls were interviewed at 9 teaching hospitals in London and Oxford and asked about their use of oral contraceptives. The results were reassuring. A few statistically significant differences in oral contraceptive use were found between the breast cancer and control groups, but the data were subdivided in many ways so that some "significant" differences would have been expected through the play of chance alone. Certainly no patterns of risk emerged which would suggest that any of the associations were causal. It must be stressed, however, that the data are still sparse in some important subcategories--for example, only small numbers of both cases and controls had prolonged oral contraceptive use before their first term pregnancy. For this reason, it is important that information on the possible relationship between pill use and breast cancer should continue to be collected. Women who had never used oral contraceptives presented with appreciably more advanced tumours than those who had been using oral contraceptives during the year before detection of cancer, while past users were in an intermediate position. These differences in staging were reflected in the pattern of survival. Possible explanations for these observations include "surveillance bias" among oral contraceptive users leading to earlier diagnosis and a beneficial biological effect of oral contraceptives on tumour growth and spread. Women with breast cancer reported never having used any method of contraception and heavy cigarette smoking (greater than or equal to 15 per day) significantly less often than controls. We could find no obvious explanation for the former observation, but suspect that the latter reflects the unrepresentative smoking habits of our hospital controls rather than a protective effect of smoking against breast cancer.

Adolescent↗
PubMed1982

Importance of the male factor in cancer of the cervix.

A woman's risk of cervical cancer is generally thought to be related to her sexual behaviour. The sexual background of her male partners is also important. In some societies, a woman's risk of cancer of the cervix will depend less on her own behaviour than on that of her partner. Male sexual behaviour, particularly in relation to prostitution, may account for two hitherto unexplained features of the epidemiology of this disease--the extremely high incidence in Latin America and the decline in mortality this century. If this is so and men carry the aetiological agent, it will be important to discover whether they do so for short or long periods.

Education↗
PubMed1982

Mortality among patients with ankylosing spondylitis after a single treatment course with x rays.

Mortality was studied in 14 111 patients with ankylosing spondylitis given a single course of x-ray treatment during 1935-54. Mortality from all causes combined was 66% greater than that of members of the general population of England and Wales. There were substantial excesses of deaths from non-neoplastic conditions, but these appeared to be associated with the disease itself rather than its treatment. A nearly fivefold excess of deaths from leukaemia and a 62% excess of deaths from cancers of sites that would have been in the radiation fields ("heavily irradiated sites") were likely to have been a direct consequence of the radiation treatment itself. The excess death rate from leukaemia was greatest three to five years after treatment and was close to zero after 18 years. In contrast, the excess of cancers of heavily irradiated sites did not become apparent until nine or more years after irradiation and continued for a further 11 years. More than 20 years after irradiation the excess risk declined, but the fall was not statistically significant. The number of cancers of sites not considered to be in the radiation beams was 20% greater than expected. This excess, although not statistically significant, may also have been due to radiation scattered from beams directed at other parts of the body. The risk of a radiation-induced leukaemia or other cancer was related to the age of the patient at the time of treatment. Those irradiated when aged 55 years or more had an excess death rate from leukaemia more than 15 times that of those treated under 25 years of age, and a similar difference was apparent for cancers of heavily irradiated sites. The radiation dose to the bone marrow was estimated for the patients who died with leukaemia and for a 1 in 15 sample of the total study population. The excess risk of leukaemia varied erratically with radiation dose owing, perhaps, in part to the increase in the proportion of the cells in the bone marrow that are sterilised with increasing doses. A mathematical model using a linear leukaemia induction rate and exponential cell sterilisation fitted the data reasonably well, and the results suggested that for low radiation doses about two deaths from leukaemia would be induced per million people per rad of x rays per year for up to 20 years after exposure. Because of the failure to find a clear dose-response relationship this estimate must be regarded with caution, but it is in reasonable agreement with that derived from studies of the atomic bomb survivors.

Adult↗
PubMed1982

Oral contraceptive use and abortion before first term pregnancy in relation to breast cancer risk.

A recent publication from California in this journal has suggested that both prolonged oral contraceptive use and abortion before first term pregnancy increases the risk of breast cancer in young women. Data are presented on 1176 women aged 16-50 years with breast cancer, interviewed in London or in Oxford, together with a like number of matches control subjects. The results are entirely reassuring, being, in fact, more compatible with protective effects than the reverse. Possible reasons for the differences between the 2 sets of data are discussed.

Abortion, Spontaneous↗
PubMed1981

Case-control study of the husbands of women with dysplasia or carcinoma of the cervix uteri.

The husbands of married women with cervical dysplasia, carcinoma-in-situ, or invasive carcinoma of the cervix who, in an earlier study, had claimed to have had no sexual partner other than their husband, were interviewed to determine whether the risk of cervical epithelial abnormalities in the women could be related to their husband's sexual background. Of 322 women previously studied, 57 were eligible for this study and the husbands of 31 of them were interviewed together with the husbands of a control group, matched for age and age at first intercourse. The number of sexual partners reported by the husband was found to be a significant risk factor, with a relative risk of 7.8 for 15 or more partners outside marriage. The relative risk for women who smoked was 7.0, and this was independent of any of the sexual risk factors. The findings for subgroups of women with invasive carcinoma and with dysplasia or carcinoma-in-situ were similar. The data strongly support the view that an infectious agent is involved in the aetiology of cancer of the cervix and suggest that smoking may have an independent carcinogenic action.

Adult↗
PubMed1981

Breast cancer and oral contraceptives: findings in Oxford-Family Planning Association contraceptive study.

Among the 17 032 women taking part in the Oxford-Family Planning Association contraceptive study, 72 were first diagnosed as having breast cancer between the date they were admitted to the study and 1 September 1980. The relative risk of developing the disease in women who had used oral contraceptives in comparison with those who had never used them was estimated to be 0.96 (95% confidence limits 0.59 to 1.63). Among women aged under 35 years, the corresponding relative risk (based on only 14 women with breast cancer) was estimated to be 0.61. No relation was apparent between the risk of developing breast cancer and duration of oral-contraceptive use or interval since first oral-contraceptive use in any age group. The data in this study are thus reassuring; but observations based on women with long-term use of oral contraceptives, especially those starting to use the preparations at an early age, are few.

Adult↗
PubMed1981

Can dietary beta-carotene materially reduce human cancer rates?

Human cancer risks are inversely correlated with (a) blood retinol and (b) dietary beta-carotene. Although retinol in the blood might well be truly protective, this would be of little immediate value without discovery of the important external determinants of blood retinol which (in developed countries) do not include dietary retinol or beta-carotene. If dietary beta-carotene is truly protective--which could be tested by controlled trials--there are a number of theoretical mechanisms whereby it might act, some of which do not directly involve its 'provitamin A' activity.

Africa, Eastern↗
PubMed1981

Trends in tar, nicotine, and carbon monoxide yields of UK cigarettes manufactured since 1934.

The tar, nicotine, and carbon monoxide yields of cigarettes manufactured in the United Kingdom between 1934 and 1979 were studied. Over this period the average tar yield decreased by 49%, the nicotine yield by 31%, the carbon monoxide yield by 11%, all estimated on a sales-weighted basis. The average tar yield decreased progressively after the second world war, owing both to the introduction of filter cigarettes and to changes in the manufacture of plain cigarettes. The average nicotine yield increased initially, decreased by 43% from about 1950 to 1974, but increased again by 9% between 1974 and 1979. The average carbon monoxide yield started to decrease after about 1961; while it decreased substantially in plain cigarettes, the rapid increase in sales of filter cigarettes at this time, at the expense of plain cigarettes, largely offset the reduction in carbon monoxide yield that would otherwise have occurred. As with nicotine, carbon monoxide yield showed a small rise in later years (4% between 1976 and 1979). The trends in tar yield may well explain the reduction in lung cancer in the UK better than has been suspected hitherto. The trends in nicotine and carbon monoxide yields are probably not sufficiently different to distinguish which of them might be the more likely cause of cardiovascular disease.

Carbon Monoxide↗