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Biomedical subjects

R Doll

Publications and source records attributed to R Doll.

At least 199 records · Page 11Linked to original sources
PubMed1981

Cancer of the larynx and other occupational hazards of mustard gas workers.

An attempt was made to tract 511 men and women who manufactured mustard gas during the 1939--1945 war. Despite limitations in the identifying data available, 428 (84%) were traced to the end of 1974. The numbers of deaths from all neoplasms combined (45) and from all other causes (136) were slightly greater than those expected from national death rates, but not significantly so. Two deaths were attributed to carcinoma of the larynx and one to carcinoma of the trachea, compared with an expected number of 0.40 (P less than 0.02). Carcinoma of the larynx was also mentioned on the death certificate of another man. Seven subjects are known to have developed cancer of the larynx, compared with 0.75 expected (P less than 0.001). Excess mortality was also observed from cancer of the lung, pneumonia and accidents, but the excesses were small and difficult to interpret.

Adult↗
PubMed1981

Record linkage for drug monitoring.

A study was carried out to assess the feasibility of using record linkage for drug monitoring. For two years, three types of records were collected for a total of 43 117 people: (1) details of basic attributes, such as sex and age; (2) details of prescriptions dispensed; and (3) records of hospital admissions, obstetric deliveries, and deaths. The records about each person were linked together, and analyses were performed to reveal associations between drugs and diagnoses. The study suggested that record linkage would be useful both for generating and for testing hypotheses about the adverse effects of drugs. The method would be especially valuable for detection of delayed effects (such as the induction of cancer), sudden deaths outside hospital, and effects of the fetus-all of which are difficult to study by other means. A full-scale project would need to cover a large population, and some of the practical issues that would arise are discussed.

Aged↗
PubMed1981

Assessment of the "E' book as a tool for drug monitoring.

For two years, the following records were linked for 10 453 people: (1) basic attributes; (2) details of prescriptions; and (3) information about illnesses recorded by general practitioners (GPs) in an "E' book. Analyses were performed to reveal association between drugs and diagnoses. Although the "E' book has certain disadvantages for drug monitoring, the methods proved to be capable of detecting adverse effects of drugs. Unfortunately the number of practitioners using "E' books would be too small for detection of most serious hazards such as the induction of cancer. Hence it is concluded that the first priority should be to establish a record linkage scheme covering hospital admissions, obstetric deliveries, and deaths.

Acute Disease↗
PubMed1981

Mortality of nickel workers: experience of men working with metallic nickel.

The mortality of men employed in a plant manufacturing nickel alloys from metallic nickel and other metals has been examined. The plant has operated since May 1953, and 1925 men were identified who had been employed in the operating areas at the plant, other than as members of the staff, for a total of five or more years, excluding breaks. Analysis of samples of air obtained from personal samplers showed that since 1975 most of the men are likely to have been exposed to average concentrations of nickel of between 0.5 and 0.9 mg Ni/m3. All but 22 (1.1%) of the men were successfully traced to 1 April 1978 or until they died or emigrated. One hundred and seventeen had died. The numbers of deaths observed from cancers of respiratory and other sites, other respiratory disease, ischaemic heart disease, and other causes of death were compared with the numbers expected from national and local mortality rates. No evidence of the existence of any occupational hazard was obtained. The number of deaths from lung cancer (15) in men employed for five years or more is small. At 98% of the number expected at local rates it is statistically compatible with risks of between 0.5 and 2.2 times "normal."

England↗
PubMed1981

Mortality from cancer and all causes among British radiologists.

The mortality of men who joined a British radiological society between 1897 and 1954 has been compared with that of (i) all men in England and Wales, (ii) men in social class 1, and (iii) male medical practitioners. Radiologists who entered the profession before 1921 suffered a death rate from cancer 75% higher than that of medical practitioners. Among these men there was a statistically significant excess of deaths from cancers of the pancreas (6 against 1.9 expected), lung (8 against 3.7), and skin (6 against 0.8), and from leukaemia (4 against 0.7). There were 72 deaths from cancer among men who entered the study after 1920 and 68.6 deaths were expected, based upon rates among medical practitioners. For no individual cancer site did the observed number of deaths exceed the expected number. There was some evidence however, that the ratio of observed to expected cancer increased with the duration of time that men were included in the study. Among those followed for more than 30 years there were 30 deaths against 22.1 expected. It is not possible to make a close estimate of the dose of radiation received by the men in this study, but those who entered between 1920 and 1945 could have received an accumulated whole-body dose of the order of 1-5 Gy (100 to 500 rad). For all non-cancer causes of death combined, the death rate among radiologists is lower than that among all men in England and Wales, men in social class 1, and male medical practitioners. The data offer no support for the concept of a non-specific aging effect of radiation.

Adult↗
PubMed1981

The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today.

Evidence that the various common types of cancer are largely avoidable diseases is reviewed. Life-style and other environmental factors are divided into a dozen categories, and for each category the evidence relating those particular factors to cancer onset rates is summarized. Where possible, an estimate is made of the percentage of current U.S. cancer mortality that might have been caused or avoided by that category of factors. These estimates are based chiefly on evidence from epidemiology, as the available evidence from animal and other laboratory studies cannot provide reliable human risk assessments. By far the largest reliably known percentage is the 30% of current U.S. cancer deaths that are due to tobacco, although it is possible that some nutritional factor(s) may eventually be found to be of comparable importance. The percentage of U.S. cancer deaths that are due to tobacco is still increasing, and must be expected to continue to increase for some years yet due to the delayed effects of the adoption of cigarettes in earlier decades. Trends in mortality and in onset rates for many separate types of cancer are studied in detail in appendixes to this paper. Biases in the available data on registration of new cases produce apparent trends in cancer incidence which are spurious. Biases also produce spurious trends in cancer incidence which are spurious. Biases also produce spurious trends in cancer death certification rates, especially among old people. In (and before) middle age, where the biases are smaller, there appear to be a few real increases and a few real decreases in mortality from some particular types of cancer, but there is no evidence of any generalized increase other than that due to tobacco. Moderate increases or decreases due to some new agent(s) or habit(s) might of course be overlooked in such large-scale analyses. But, such analyses do suggest that, apart from cancer of the respiratory tract, the types of cancer that are currently common are not peculiarly modern diseases and are likely to depend chiefly on some long-established factor(s). (A prospective study utilizing both questionnaires and stored blood and other biological materials might help elucidate these factors.) The proportion of current U.S. cancer deaths attributed to occupational factors is provisionally estimated as 4% (lung cancer being the major contributor to this). This is far smaller than has recently been suggested by various U.S. Government agencies. The matter could be resolved directly by a "case-control" study of lung cancer two or three times larger than the recently completed U.S. National Bladder Cancer Study but similar to it in methodology and unit costs; there are also other reasons for such a study. A fuller summary of conclusions and recommendations comprises the final section of this report.

Adult↗
PubMed1980

The epidemiology of cancer.

The epidemiology of cancer has a long history. It led to the discovery of several causes of cancer before techniques for the production of the disease in laboratory animals became available. In recent years, epidemiological studies have contributed to knowledge of cancer in five ways: by demonstrating geographical and temporal variations in incidence, by correlating incidence in different communities with the prevalence of social habits and environmental agents, by comparing the experience of individuals with and without cancer, by intervening to remove suspected agents and observing the results, and by making quantitative observations that test the applicability to man of models of the mechanism by which the disease is produced. Joint investigation of dietetic factors by epidemiologists and laboratory workers offers the brightest prospect of discovering new ways of preventing cancer in the near future. Advances in knowledge will eventually prevent the need for learning about cancer by seeing its production in man, but epidemiological enquiry will be needed for many years to monitor preventive programs and to provide quantitative measures of risk from hazards that cannot be avoided completely.

Carcinogens↗
PubMed1980

Mortality in relation to smoking: 22 years' observations on female British doctors.

A total of 6194 female doctors who in 1951 replied to a questionnaire about their smoking habits were followed up prospectively for 22 years. During that time 1094 died. Ischaemic heart disease, lung cancer, and chronic obstructive lung disease were all significantly (p < 0.001) related to smoking, though the absolute excess risks were lower than in male doctors smoking equivalent amounts. Female smokers born before the first world war were less likely to describe themselves as inhalers or as having started to smoke while young than were female smokers who were born later. In these respects this younger group resembled male smokers, and as they move into their 60s and 70s their absolute risk of lung disease and relative risk of ischaemic heart disease will probably come to resemble the risks for men smoking the same numbers of cigarettes. These findings show only that cigarette smoking causes lung cancer, chronic obstructive lung disease, and heart disease in women as in men. Whether the proportional increase in mortality from these diseases is as great in women as in men might be estimated directly from new case-control studies on men and women born since 1920.

Adult↗
PubMed1980

Characteristics of women with dysplasia or carcinoma in situ of the cervix uteri.

To identify risk factors for various cervical abnormalities, 237 women with abnoromal cervical smears and 422 control women were interviewed. Cervical biopsy specimens taken from the patients with abnormal smears were reviewed according to standard criteria by one pathologist and classified as follows: 65 carcinoma in situ, 81 severe dysplasia, 44 mild dysplasia and 47 normal histology. Factors associated with risk of mild dysplasia, severe dysplasia and carcinoma in situ were similar to those previously identified for invasive carcinoma, and included age at first intercourse, multiple sexual partners and pregnancy outside marriage. Analysis to disentangle correlated factors revealed that number of sexual partners exerted effects independently of age at first intercourse, whereas the reverse was not true. This finding fails to support suggestions that adolescence is a period when the cervix is most vulnerable to the effects of sexual behaviour. Other factors relating to risk of cervical abnormalities were smoking and use of oral contraceptives. It was not possible to show that these relationships were incidental, but further investigation is required to establish whether they are causal.

Adolescent↗
PubMed1979

Collaborative United Kingdom-Australasian study of cancer in patients treated with immunosuppressive drugs.

A collaborative study including centres in the United Kingdom, Australia, and New Zealand was instituted in 1970 to determine the incidence of cancer in patients treated for at least three months with azathioprine, cyclophosphamide, or chlorambucil. Follow-up of 3823 renal transplant recipients showed an almost 60-fold increase of non-Hodgkin's lymphoma together with an excess of squamous-cell skin cancer and mesenchymal tumours. A series of 1349 patients without transplants showed an excess of the same tumours, though to a less extent. These preliminary findings provide no clear evidence that immunosuppressive drugs produce the increased risk of most of the common cancers that might be expected from the simplest interpretation of impaired "immunosurveillance."

Adolescent↗
PubMed1979

The pattern of disease in the post-infection era: national trends.

Information that can be used to assess trends in the health of the population is limited to the results of irregular surveys of nutritional status and 'I.Q.', to data obtained from the notification of infectious diseases, congenital malformations, blindness and other selected defects, and to mortality rates. The last have been recorded since 1841 and provide the most detailed and useful information, although they are often difficult to interpret because of changes in the nomenclature, classification, methods of diagnosis, and efficacy of treatment of disease states. In the last 40 years, mortality rates have shown progressive reductions at all ages which have continued past the time when improvements in the prevention and treatment of infectious disease might be expected to have produced their principal benefits. Notable differences have emerged between the sexes, the rates continuing to decline in women but remaining more or less stable for a period in middle-aged men. This difference can be attributed to sex differences in life-style, so that until recently the trends in women are likely to have been the better indicators of the effect of toxic agents in the environment. The available data are inadequate to assess possible effects such as alterations in behaviour, but are of some help in regard to teratogenicity and carcinogenicity.

Adolescent↗
PubMed1979

An epidemiological study of oral contraceptives and breast cancer.

During 1968-77, 707 women aged 16-50 years with newly diagnosed breast cancer and 707 matched controls were interviewed at eight teaching hospitals in London and Oxford about their use of oral contraceptives. Eighty-six of the patients with breast cancer were matched with controls with gall-bladder disease; these subjects were omitted from the main analyses, which thus related to 621 case-control pairs.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 to occur by chance. The only subgroup in which the evidence for a positive association between pill use and breast cancer was at all convincing comprised women aged 46-50 years, but trends in those aged 41-45 were by and large in the opposite direction and results of combined analysis gave no cause for concern.Information on clinical stage was available for 487 patients with breast cancer treated before the end of 1975. Those who had never used oral contraceptives had appreciably more advanced tumours at presentation than those who had been using the pill during the year before detection of the lump, while past users of the pill occupied an intermediate position. This difference in staging was reflected in the pattern of survival. Oral contraceptives may have had a beneficial effect on tumour growth and spread, though diagnostic bias could not be definitely excluded.

Adolescent↗