Introduction: Cancer in relation to occupational and environmental exposures.
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Adult↗
Biomedical subjects
R R Monson
Publications and source records attributed to R R Monson.
Mortality studies of machining fluid exposure in the automobile industry. III: A case-control study of larynx cancer.
A case-control study of larynx cancer was conducted within a cohort of automobile workers exposed to metal working fluids, commonly referred to as machining fluids (MF). Results are based on 108 cases of larynx cancer and 5:1 matched controls. Risks associated with specific types of MF, as well as specific components of the fluids were evaluated. Based on a retrospective exposure assessment, lifetime exposures to straight and soluble fluids, grinding particulate, biocides, selected metals, sulfur, and chlorine were examined. Exposure to asbestos and acid mists at two of the three study sites was also characterized. Results suggest that straight mineral oils are associated with almost a two-fold excess in larynx cancer risk. There was also evidence of an association with elemental sulfur, commonly added to straight MF to improve the integrity of the materials under extreme pressure and heat. It is not clear whether sulfur is causally related to an excess relative risk of larynx cancer or whether the observed association is the result of unmeasured confounding by another contaminant or process feature. For example, the high stress operations that require MF enriched with sulfur are also more likely to produce polycyclic aromatic hydrocarbons (PAHs) during the process. Thus, the observed association with sulfur may be due to an association with PAH. The finding of excess risk of laryngeal cancer associated with MF is consistent with several previous reports in the literature. This is the first study, however, to distinguish straight mineral oils from other types of MF. Based on these findings, a general reduction in concentrations of straight mineral oil particulate in occupational environments would be prudent.
Adult↗
Predictors of human gestational length.
OBJECTIVES: Our objective was to identify statistically significant variables that determine the length of human gestation. STUDY DESIGN: Multiple linear regression was used to analyze 9355 observations from the Delivery Interview Program, a cross-sectional study conducted from 1977 through 1980 at the Boston Hospital for Women (now called the Brigham and Women's Hospital). RESULTS: Maternal parity, age, and race were found to be the most important variables determining the length of human gestation. Multiparous women, women aged < 19 or > 34 years, and black women were found to have shorter gestations than primiparous women, women aged 19 to 34 years, or white women. CONCLUSION: By means of our linear model the length of pregnancy for women with different risk factors can be estimated more precisely than Naegele's rule allows.
Adult↗
Leukemia, lymphoma, and multiple myeloma after pelvic radiotherapy for benign disease.
The relationship between exposure to sparsely ionizing radiation and mortality due to cancers of hematopoietic and lymphopoietic tissues was studied among 12,955 women treated for benign gynecological disorders at any of 17 hospitals in New England or New York State and followed for an average of 25 years; 9770 women were treated by radiation (intracavitary 226Ra, external-beam X rays), while 3185 were treated by other methods, including curettage, surgery, and hormones. The average age at treatment was 46.5 years, and the mean dose to active bone marrow among irradiated women was 119 cGy. Forty deaths due to acute, myelocytic, or monocytic leukemia were observed among irradiated women. This number was 70% higher than expected based on U.S. mortality rates [standardized mortality ratio (SMR) = 1.7; 90% confidence interval (CI) 1.3-2.3]. A deficit was recorded among nonirradiated women, based on three observed deaths (SMR = 0.5; 90% CI 0.1-1.2). A well-defined gradient in the SMR with dose among exposed women was not detected. The SMR was highest within 5 years after irradiation but remained elevated even after 30 years. The temporal pattern differed by subtype of leukemia: excess mortality due to chronic myelocytic leukemia occurred almost exclusively within the first 15 years, whereas the SMR for acute leukemia, though also elevated, varied little over time. Cancers of lymphoreticular tissue occurred more often than expected based on U.S. mortality rates, but not appreciably differently for irradiated and nonirradiated women. There was little or no evidence of effects attributable to radiotherapy for chronic lymphocytic leukemia [relative risk (RR) = 1.1; 90% CI 0.5-3.0], Hodgkin's disease (RR = 0.9; 90% CI 0.3-3.2), non-Hodgkin's lymphoma (RR = 0.9; 90% CI 0.6-1.6), or multiple myeloma (RR = 0.6; 90% CI 0.3-1.4). These results corroborate previous findings indicating that acute and myelocytic leukemias are the most prominent malignancies after exposure to sparsely ionizing radiation, occurring in excess shortly after irradiation, and that lymphomas are either not caused by radiation or are induced only rarely.
Bone Marrow↗
Relations over time between psychiatric and somatic disorders: the Stirling County Study.
A longitudinal study of a general population in Atlantic Canada provided information on associations between two broad categories of illness: somatic disorders and disorders involving depression and/or anxiety. Prevalence was investigated in a sample of 1,003 adults selected in 1952 and another sample of 1,094 adults selected in 1970. Using a cohort of 618 survivors from the 1952 sample who were followed up in 1968, the authors studied prevalence at the beginning and end of the 16-year period. Incidence was also investigated so that the strength of associations between prior illness of one type and subsequent illness of the other type could be assessed. Data were obtained by interviewing subjects with the same structured schedule at each time of investigation. In prevalence enumerations, psychiatric disorders were found to be significantly associated with somatic disorders. Prior somatic disorder was significantly associated with subsequent incidence of depression and/or anxiety and vice versa. The results did not, however, show one direction of influence ("psyche-to-soma" or "soma-to-psyche") to be markedly stronger than the other. The results mainly support the concept of "generalized vulnerability" and draw attention to the importance of recognizing comorbidity in diagnosis and clinical practice.
Adult↗
Cigarettes, coffee, and preterm premature rupture of the membranes.
Premature (prior to 37 completed weeks of gestation) rupture of the membranes (preterm PROM) is one of the most common underlying causes of preterm delivery. However, there have been few epidemiologic studies of this obstetric complication. The authors studied the relation of maternal cigarette smoking and coffee consumption to both preterm PROM and spontaneous preterm labor not complicated by premature rupture of the membranes (preterm NONPROM) in a large cross-sectional data base. The 307 preterm PROM and 488 preterm NONPROM cases who delivered during 1977-1980 at the Boston Hospital for Women were compared with 2,252 randomly selected women who delivered at term at that institution. Multiple logistic regression techniques were used to derive maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). After confounders had been adjusted for, the relative risk of preterm PROM for women who reported ever having smoked during pregnancy, as compared with nonsmokers, was 1.6 (95% CI 1.1-2.4). However, no gradient between the number of cigarettes smoked per day and the risk of preterm PROM was observed. Similar results were observed for preterm NONPROM. Women who consumed three or more cups of coffee daily during the first trimester had a 2.2-fold greater risk of preterm PROM than did women who drank two or fewer cups (95% CI 1.5-3.3). Among coffee drinkers, there was some evidence of a linear trend in the risk of preterm PROM as coffee consumption increased. Consumption of three or more cups of coffee per day was less strongly associated with the occurrence of preterm NONPROM (adjusted OR = 1.4, 95% CI 1.0-1.9).
Adolescent↗
Mortality studies of machining fluid exposure in the automobile industry I: A standardized mortality ratio analysis.
Machining fluids are widely used in a variety of common industrial metalworking operations to lubricate and cool both the tool and the working surfaces. Previous studies have suggested elevated respiratory, digestive, and skin cancers in exposed populations. This cohort study was initiated to assess whether long-term exposure to machining fluids in the course of machining, grinding, and other cutting operations is associated with excess cancer mortality. The cohort includes more than 45,000 automobile production workers from 3 plants, almost 1 million years of follow-up, over 10,000 deaths, and an extensive exposure assessment component. Standardized mortality ratios (SMRs) have been estimated for each of the 3 plants, using both U.S. as well as local populations as reference. Relative risks of 1.2-3.1 have been observed for several specific respiratory and digestive cancers of a priori interest, including cancer of the stomach, large intestine, pancreas, lung, and larynx. In addition, elevated risks for leukemia and asthma were noted. Future exposure-response analyses will provide the opportunity to identify relatively modest excesses in cause-specific mortality risk associated with exposure to specific types (straight, soluble, or synthetic), additives, or components of machining fluids.
Automobiles↗
Benign thyroid diseases and the risk of death from breast cancer.
A survey of the causes of death among women with benign thyroid disease was conducted to assess the risk of breast cancer mortality in thyroid patients. The study population was all women diagnosed with one of several types of thyroid disease at the Massachusetts General Hospital Thyroid Clinic from 1925 to 1974. A population-based comparison group was matched to the Clinic patients for age and socioeconomic status, resulting in a total of 9,520 matched pairs. A search of the Massachusetts mortality records located death certificates for 10.9% (1,039) of the Thyroid Clinic patients and 10.5% (995) of the comparison women. Cancer was the cause of death in 21% (218) of the Thyroid Clinic patients and 24% (239) of the comparison women. Fewer patients than comparison women died from cancers of the digestive organs (30.2 vs. 45.5%), but more patients died from thyroid cancer (3.7 vs. 0%), lymphatic and hematopoietic cancers (11.5 vs. 4.2%), and cancers of other sites (8.3 vs. 3.8%). Breast cancer deaths accounted for 21.6% of cancer deaths in the patients and 22.2% of cancer deaths in the comparison women. When specific thyroid diagnoses were considered, the percent of all deaths due to breast cancer ranged from 1.9 to 5.6%, compared to 5.3% in the comparison women. Of the diagnostic groups studied, patients with Hashimoto's thyroiditis had the lowest percent of deaths due to breast cancer, while those with nontoxic nodular goiter had the highest.
Adult↗
Mortality studies of machining-fluid exposure in the automobile industry. II. Risks associated with specific fluid types.
Excesses of digestive and respiratory cancers have been reported previously in association with exposure to machining fluids, agents in widespread use as coolants and lubricants in machining operations. Previous studies have had limited power to distinguish the effects of the different types of machining fluids in use. In a cohort of over 30,000 workers employed at two automotive plants in Michigan, mortality patterns were studied in relation to exposure to each of the three major fluid types--straight oils, soluble oils, and synthetic fluids. Standardized mortality ratios were estimated for subgroups of the cohort ever exposed to each of the three fluid types, and Poisson regression analyses were used to assess trends in risk with duration of exposure. The data suggest modest positive associations between exposure to straight oils and rectal, laryngeal, and prostatic cancer and a negative association between soluble and synthetic fluid exposure and lung cancer.
Adult↗
Risk factors for abruptio placentae.
The authors studied the relation of sociodemographic, medical, and life-style factors and abruptio placentae in a large cross-sectional data base. The 143 cases of abruption identified in the Delivery Interview Program, conducted in Boston from 1977 to 1980, were compared with 1,257 randomly selected controls. The authors used multiple logistic regression techniques to derive maximum likelihood estimates of the adjusted odds ratios and 95% confidence intervals as measures of the association between exposure factors and abruption. A history of chronic hypertension was associated with a threefold increase in risk (odds ratio (OR) = 3.1, 95% confidence interval (Cl) 1.1-8.4), but pregnancy-induced hypertension was not associated with abruption. Excess risk was associated with advanced maternal age (OR = 2.3, 95% Cl 1.3-3.9), low prepregnancy body mass index (OR = 2.3, 95% Cl 1.3-4.1), a history of prior stillbirth (OR = 3.5, 95% Cl 1.8-7.0), and at least weekly use of marijuana during pregnancy (OR = 2.8, 95% Cl 1.2-6.6). Overall, the association with cigarette smoking during pregnancy was of only borderline significance (OR = 1.5, 95% Cl 1.0-2.2), although there appeared to be a dose-response relation between the number of cigarettes smoked and risk of abruption.
Abruptio Placentae↗
Depression and anxiety in relation to social status. A prospective epidemiologic study.
Longitudinal research in Stirling County, Atlantic Canada, indicated that during the 1950s and 1960s the prevalence of depression was significantly and persistently higher in the "low" socioeconomic status population than at other socioeconomic status levels. Anxiety was found to show a less clear picture. Incidence of depression after the study started was also higher among those who were initially in the low socioeconomic status group, supporting the view that the stress of poverty may be causally related to depression. There was also a trend for prior depression to be associated with subsequent downward social mobility, supporting the view that the concentration of depressed people at the lower end of the social hierarchy may result from handicapping aspects of the illness. Neither of these trends was statistically significant. More striking was evidence that, irrespective of socioeconomic status, depression carried a substantial risk for poor clinical course and outcome. Both depression and poverty tended to be chronic, and, accordingly, their association at the end of the study was influenced by their association at its beginning. The stability of the relationship between poverty and depression warrants the attention of caregivers and policymakers and raises new questions about strategies for the study of causal sequences.
Adult↗
Cigarette smoking during pregnancy in relation to placenta previa.
To evaluate the relationship between cigarette smoking and the occurrence of placenta previa, we used interview and medical record data to conduct a case-control analysis of 69 placenta previa cases and 12,351 controls. The unadjusted relative risk estimate of placenta previa for women reported to have "ever smoked" during pregnancy relative to nonsmoking mothers was 1.9 (95% confidence interval, 1.2 to 3.0). The risk rose after adjusting for potential confounders (odds ratio, 2.6; 95% confidence interval, 1.3 to 5.5). In contrast to a previous report, the duration of smoking was not an independent risk factor for placenta previa. These results suggest that cigarette smoking during pregnancy is a determinant of placenta previa. Carbon monoxide hypoxemia, which is one possible mechanism for this association, may result in compensatory placental hypertrophy. Placentas with increased surface areas are more likely to cover the cervical os, causing placenta previa.
Adult↗
Subfertility and the risk of low birth weight.
OBJECTIVE: We evaluated the association between subfertility and low birth weight infants. DESIGN: Women in this analysis participated in a cross-sectional investigation of maternal risk factors for adverse pregnancy outcomes. SETTING: Medical and obstetric history and life style information were obtained from women who delivered at the Boston Hospital for Women, 1977 to 1980. PATIENTS, PARTICIPANTS: Our analysis was restricted to nondiabetic married women who planned their pregnancies and subsequently delivered viable singletons (3,622). The 644 "subfertile" women (no conception during a year of unprotected intercourse) were compared with 2,978 "fertile" women (conception within 1 year). MAIN OUTCOME MEASURE(S): The relative risk of low birth weight was estimated using the cumulative incidence risk ratio. RESULTS: After adjusting for confounding, the relative risk of delivering a low birth weight infant (less than 2,500 g) for subfertile women versus fertile women was 1.9 (95% confidence interval [CI], 1.3 to 2.8). The adjusted relative risk of delivering a term low birth weight (intrauterine growth retarded) infant was 2.3 (95% CI, 1.2 to 4.4). CONCLUSIONS: In these data, subfertility is a predictor for low birth weight. The association may result from endocrinological, immunological, cervical, or other factors that interfere with optimal fetal growth.
Coffee↗
Chronic hypertension, cigarette smoking, and abruptio placentae.
We investigated the importance of maternal hypertension and cigarette smoking, and their interaction, as risk factors for abruptio placentae, using Massachusetts birth certificate data for 1987-1988. We used multiple logistic regression procedures to model data from 943 abruptio placentae cases and 10,648 randomly selected births. Risk of abruption was associated with a history of chronic hypertension (adjusted OR = 2.3, 95% CI: 1.5-3.5) and cigarette smoking during pregnancy (adjusted OR = 1.7, 95% CI: 1.5-2.0). There was also evidence of interaction between chronic hypertension and cigarette smoking. The hypoxemia that results from exposure to cigarette smoke and the alterations in uterine blood flow that result from hypertension may lead to placental lesions that cause abruption.
Abruptio Placentae↗
Frequent chest X-ray fluoroscopy and breast cancer incidence among tuberculosis patients in Massachusetts.
The incidence of breast cancer was determined in 4940 women treated for tuberculosis between 1925 and 1954 in Massachusetts. Among 2573 women examined by X-ray fluoroscopy an average of 88 times during lung collapse therapy and followed for an average of 30 years, 147 breast cancers occurred in contrast to 113.6 expected [observed/expected (O/E) = 1.29; 95% confidence interval (CI) = 1.1-1.5]. No excess of breast cancer was seen among 2367 women treated by other means: 87 observed versus 100.9 expected. Increased rates for breast cancer were not apparent until about 10 to 15 years after the initial fluoroscopy examination. Excess risk then remained high throughout all intervals of follow-up, up to 50 years after first exposure. Age at exposure strongly influenced the risk of radiation-induced breast cancer with young women being at highest risk and those over age 40 being at lowest risk [relative risk (RR) = 1.06]. Mean radiation dose to the breast was estimated to be 79 cGy, and there was strong evidence for a linear relationship between dose and breast cancer risk. Allowing for a 10-year minimum latent period, the relative risk at 1 Gy was estimated as 1.61 and the absolute excess as 10.7 per 10(4) woman-years per gray. When compared to other studies, our data suggest that the breast is one of the most sensitive tissues to the carcinogenic force of radiation, that fractionated exposures are similar to single exposures of the same total dose in their ability to induce breast cancer, that risk remains high for many years after exposure, and that young women are especially vulnerable to radiation injury.
Breast Neoplasms↗
Adverse infant outcomes associated with first-trimester vaginal bleeding.
We assessed the association between first-trimester vaginal bleeding and singleton infant outcomes in a hospital-based population of 11,444 nondiabetic women. Low birth weight (LBW), shortened gestation, LBW at term, and neonatal death occurred more often in women reporting first-trimester bleeding than in those who never bled. These relationships remained statistically significant after adjusting for confounding factors. Women who experienced vaginal bleeding limited to the first trimester (N = 1174) had double the risk of delivering a preterm infant compared with those experiencing no bleeding (adjusted risk ratio = 2.0; 95% confidence interval 1.6-2.5). Bleeding limited to the first trimester was associated with a 1.6-fold risk of delivery of a term LBW infant (95% confidence interval 1.3-2.0). These results suggest that first-trimester vaginal bleeding is an important correlate of adverse infant outcomes.
Adult↗
Cancer mortality in women with thyroid disease.
A retrospective follow-up study of 7338 women with either nontoxic nodular goiter, thyroid adenoma, hyperthyroidism, hypothyroidism, Hashimoto's thyroiditis, or no thyroid disease was conducted. All women patients at the Massachusetts General Hospital Thyroid Clinic who were seen between 1925 and 1974 and who were treated for a minimum of 1 year were traced. A total of 2231 women (30.4%) were dead and 2012 women (27.4%) were alive as of December 31, 1978. Partial follow-up information was available for the remaining 3095 women (42.2%). The average length of follow-up was 15.2 years. When losses to follow-up were withdrawn at the time of their loss, the standardized mortality ratios (SMR) for all causes of death were 1.2 [95% confidence interval (CI), 1.1-1.3] for women with nontoxic nodular goiter, 1.2 (95% CI 1.0-1.3) for those with thyroid adenoma, 1.4 (95% CI 1.3-1.5) for women with hyperthyroidism, 1.5 (95% CI 1.3-1.7) for hypothyroid women, 1.2 (95% CI 0.9-1.5) for those with Hashimoto's thyroiditis, and 1.5 (95% CI 1.4-1.6) for those without thyroid disease. For deaths from all cancers, the standardized mortality ratios were 1.5 (95% CI 1.2-1.8) for women with nontoxic nodular goiter, 1.5 (95% CI 1.1-1.9) for those with thyroid adenoma, 1.2 (95% CI 1.0-1.4) for women with hyperthyroidism, 1.0 (95% CI 0.7-1.4) for the hypothyroid women, 1.2 (95% CI 0.7-2.1) for those with Hashimoto's thyroiditis, and 1.3 (95% CI 1.0-1.5) for those women without thyroid disease. When specific cancer sites were studied, excess numbers of deaths were observed from breast cancer in women with nontoxic nodular goiter (SMR = 1.6, 95% CI 1.0-2.6) and from lymphatic and hematopoietic cancer in women with nontoxic nodular goiter (SMR = 2.4, 95% CI 1.2-4.3) and thyroid adenoma (SMR = 2.7, 95% CI 1.1-5.2). An increase in thyroid cancer risk was observed in women with thyroid adenoma (SMR = 11.7, 95% CI 1.3-42.1) but was based on only two deaths. In hyperthyroid women, statistically significant increases in the number of deaths were observed from pancreatic cancer (SMR = 2.6, 95% CI 1.4-4.3) and respiratory cancer (SMR = 2.2, 95% CI 1.3-3.5), but not breast cancer (SMR = 1.3, 95% CI 0.8-1.8). When the data were stratified by the time between the onset of thyroid symptoms and death, a nonsignificant excess number of cancer deaths was observed in hyperthyroid women who died 20 or more years after their symptoms began.(ABSTRACT TRUNCATED AT 400 WORDS)
Adenoma↗