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Biomedical subjects

S D Stellman

Publications and source records attributed to S D Stellman.

At least 37 records · Page 2Linked to original sources
PubMed1997

Smoking and pancreatic cancer in men and women.

Most studies of smoking and pancreatic cancer have used male subjects or combined men and women together in statistical analyses. There is little information on the relative risk of smoking and pancreatic cancer in women. Because of the high case-fatality rate, many of these studies were also based on information gathered from proxy respondents, in which smoking habits may not be recalled with certainty. A hospital-based study of 484 male and female patients with pancreatic cancer and 954 control subjects was conducted based on direct interviews of incident cases. Compared to never smokers, the odds ratio (OR) for current cigarette smokers was 1.6 [95% confidence interval (CI), 1.1-2.4] for men and 2.3 (95% CI, 1.4-3.5) for women. In women, but not in men, there was a trend in the ORs with years of daily cigarette consumption (P < 0.01). Filter cigarettes offered no protective advantage compared to nonfilter cigarettes. Among men, the OR was 2.1 (95% CI, 1.2-3.8) for pipe/ cigar smokers and 3.6 (95% CI, 1.0-12.8) for tobacco chewers. Tobacco smoke causes pancreatic cancer when inhaled into the lungs. Tobacco juice may also cause pancreatic cancer when ingested or absorbed through the oral cavity. These data suggest that smoking is a cause of pancreatic cancer in women and that the risks for female smokers are comparable to male smokers. Nevertheless, the causes of most pancreatic cancers are unknown.

Aged↗
PubMed1997

Cigarette smoking and large cell carcinoma of the lung.

Large cell carcinoma is the fourth most common histological type of lung cancer in the United States. Cigarette smoking causes large cell lung cancer, but it is uncertain whether the effect varies with the amount and duration of smoking. This uncertainty stems from ambiguity in the histopathological classification of large cell cancer, especially before 1971, and the relatively infrequent occurrence of large cell cancer in epidemiological studies. The present case-control investigation demonstrates that the risk of large cell cancer increases with both the frequency and number of years of cigarette smoking. The odds ratio associated with smoking two or more packs/day was 37.0 (95% confidence interval, 16.4-83.2) in men and 72.9 (35.4-150.2) in women. It is concluded that cigarette smoking is the predominant cause of large cell lung cancer.

Adult↗
PubMed1997

Tobacco smoking, cancer and social class.

Consumption of tobacco products, both by smoking and by other means, has long been causally connected with cancers of the lung, larynx, mouth and pharynx, oesophagus, bladder, and many other sites. Tobacco is the main specific contributor to total mortality in many developed countries and has become a major contributor in the developing countries as well. In most industrialized countries, prevalence of cigarette smoking is currently higher in low than in high social classes, although in some industrialized countries smoking was more frequent in high social classes during the first half of this century. The latter pattern of tobacco consumption is more likely to apply to developing countries. To formulate and carry out effective tobacco control activities it is essential to assess the relative incidence of tobacco-related cancers in different social strata and the prevalence of tobacco use across strata. Despite many years of data gathering the information base is far from complete, especially in developing countries where tobacco use is increasing rapidly, and where aggressive marketing by the transnational tobacco industry is occurring. A critical question is the extent to which tobacco usage can 'explain' the observed social class differences in cancer risk. Class differences in lung cancer are likely to be mostly related to the unequal distribution of tobacco smoking between social classes, and in some fairly simple situations this has been satisfactorily demonstrated. Nevertheless, there are many unresolved issues, especially with regard to the role of collateral exposures, such as hazardous occupations, poor diet, and limited access to health care. The question of whether tobacco use 'explains' socioeconomic differences in one or more of the cancers that it causes has rarely been directly addressed in epidemiological studies.

Adolescent↗
PubMed1996

Accuracy of death certificate completion: the need for formalized physician training.

OBJECTIVE: To assess the extent to which accuracy of death certificate completion varies with level of physician training and experience. DESIGN AND SETTING: In a classroom setting, subjects were presented with six written cases of hospital deaths adapted from materials from the National Center for Health Statistics and were asked to complete the cause-of-death section of the New York City death certificate. PARTICIPANTS: A total of 12 practicing general internists, 21 internal medicine residents, and 35 senior medical students. OUTCOME MEASURES: The underlying cause of death recorded by each participant was compared with the correct cause determined by a nosologist. Agreement and disagreement were classified as major or minor depending on concordance within the 17 International Classification of Diseases categories. RESULTS: Only one internist and five residents had received formal training in death certificate completion. The overall level of agreement between underlying cause of death reported by the three groups of participants and the correct cause was 56.9% for internists, 56.0% for residents, and 55.7% for medical students, although agreement varied with the type of case, ranging from 15% to 99%. CONCLUSION: If the misclassification observed in this pilot study were widespread, it would imply a substantial underreporting of mortality from both circulatory diseases and diabetes. These data strongly support the need to include training in death certificate completion as part of physician education.

Cause of Death↗
PubMed1996

Smoking prevalence in neighborhood and hospital controls: implications for hospital-based case-control studies.

It is widely believed that the prevalence of smoking among hospital patients is greater than that of the general population because many conditions for which patients are hospitalized are caused by or associated with smoking, and that this increased prevalence may bias results of case-control studies of tobacco-related diseases. For this reason, many authors have suggested excluding from the control series patients hospitalized for tobacco-related illnesses. The present study investigated potential selection bias for hospital compared to neighborhood controls in studying tobacco-related diseases. The 709 cases from six U.S. cities had tobacco-related cancers or myocardial infarction. They were individually matched to one hospital control and to one neighbor. After excluding patients with tobacco-related diseases, hospital controls were less often current smokers and more often former smokers than neighborhood controls. Among male ever smokers, hospital controls tended to smoke more cigarettes per day than neighborhood controls. Compared with the U.S. population, there was an overrepresentation of smokers in neighborhood controls rather than an under-representation of smokers in hospital controls. Relative risk estimates varied according to type of control. Choosing between hospital and neighborhood controls in case-control studies should be dictated by criteria related to the study hypothesis, participation, or cost. In particular, exclusion of hospital controls with diseases known to be tobacco-related seems to be a successful strategy for reducing selection bias.

Adult↗
PubMed1996

Proportional mortality ratios among Korean immigrants to New York City, 1986-1990.

BACKGROUND: About 13,000 people immigrated to New York City from the Republic of Korea between 1986 and 1990, creating an important ethnic minority. METHODS: Using US-born Whites as a reference, age-adjusted proportional mortality ratios were computed for 314 men and 248 women of Korean ancestry born abroad who died in New York City in 1986-90. RESULTS: Males had a significant excess of viral hepatitis, cancer, stroke, and external causes: accidents, suicide, and homicide. They had significantly reduced proportional rates of AIDS and heart disease. Mortality patterns were similar for Korean women, who had significantly increased proportional rates of stroke and accidents, and reduced heart disease. Stomach and liver cancers were significantly elevated in both sexes, while female breast cancer was low. There were two male and one female tuberculosis deaths (4 to 7 fold increase), and one Korean woman died of childbirth complications (59-fold increase). CONCLUSIONS: Except for violent deaths, these observations resemble known mortality patterns in Korea.

Adolescent↗
PubMed1995

Relation between exposure to environmental tobacco smoke and lung cancer in lifetime nonsmokers.

To assess the relation between exposure to environmental tobacco smoke throughout life and lung cancer in lifetime nonsmokers, the authors conducted in-person interviews with 41 male and 69 female never-smoking lung cancer cases and 117 male and 187 female never-smoking controls between 1983 and 1990 as part of a hospital-based case-control study of tobacco-related cancers. Cases had newly diagnosed, histologically confirmed primary carcinoma of the lung. Controls were matched to cases on age (+/- 5 years), sex, race, hospital, and year of interview. Subjects were asked about environmental tobacco smoke exposure in childhood, in adulthood at home, in different jobs, and in transportation and social situations. In addition to amount smoked by family members in the subject's presence, subjects were asked to rate the intensity of each exposure, and married subjects were asked whether their spouse smoked in the bedroom. Several independent indicators of exposure to smoking by spouses were strongly correlated, thereby increasing confidence in the classification of exposure status. The reproducibility of environmental tobacco smoke variables was good for qualitative measures (yes/no), in agreement with previous studies. There were few associations of exposure in specific settings with lung cancer. Males whose wives smoked had odds ratio of 1.60 (95% confidence interval (CI) 0.67-3.82) and females whose husbands smoked had an odds ratio of 1.08 (95% CI 0.60-1.94). While this study had limited sample size, the pattern of odds ratios shows little indication of an association of environmental tobacco smoke with lung cancer in nonsmokers.

Adult↗
PubMed1995

Insulation, asbestos, smoking habits, and lung cancer cell types.

The association between occupational exposure to asbestos and histological type of lung cancer was analyzed in a multicenter hospital-based case-control study (2,871 male cases and 5,240 male controls) conducted from 1981-1991. Twenty-two percent of cases and 18% of controls were employed in asbestos-related occupations for at least 1 year. Most of these asbestos jobs were in the construction field. The odds ratio (OR) among current smokers was 1.0 [95% confidence intervals (CI) 0.9 to 1.3]; for ex-smokers, the OR was 1.4 (95% CI 1.1 to 1.6). In contrast, 10% of cases and 5% of controls self-reported that they were chronically exposed to asbestos for at least 1 year. Self-reported asbestos exposure was significantly related to all lung cancer cell types among smokers and ex-smokers, although a trend in the ORs with duration of self-reported exposure was not found for current smokers. Among 48 cases and 52 controls reporting distinct exposure to building insulation, the OR was 2.2 (95% CI 1.2 to 4.3) for current smokers, and 1.8 (95% CI 0.9 to 3.6) for ex-smokers, compared to subjects who were not exposed to building insulation and asbestos. A nonsignificant association with self-reported exposure to asbestos was observed for a small number of never smokers (eight of 83 nonsmoking cases, OR = 2.0, 95% CI 0.9 to 4.6). When examining these results and their causal implications, possible misclassification and reporting biases need to be considered.

Asbestos↗
PubMed1995

Social factors: women and cancer.

Numerous factors in the social environment may affect the incidence and mortality from cancer in women. Women's work roles, possible exposure to workplace hazards, social class, social roles, social stress, access to health care, and health behaviors are among the factors that act together to help determine a woman's health and well-being.

Female↗
PubMed1994

Nonsteroidal antiinflammatory drugs and colorectal cancer.

BACKGROUND: The association between the use of nonsteroidal antiinflammatory drugs (NSAID) and large bowel cancer was examined in a hospital-based case-control study of 511 patients with colorectal cancer and 500 age-sex matched control subjects. METHODS: Regular NSAID use was defined as at least 3 times per week for 1 or more years before the date of hospital admission. Odds ratios (OR) were calculated by the duration of NSAID use and according to the medical reasons given for taking NSAIDs. RESULTS: The prevalences of regular NSAID use were 15% for male patients, 8% for female patients, and 20% for control subjects. Overall, NSAID use was associated with a statistically significant risk reduction in men (OR = 0.64; 95% confidence interval [CI], 0.42-0.97) and in women (OR = 0.32; 95% CI, 0.18-0.57). The estimate decreased with duration among men but increased with duration among women. The risk reduction among patients who took NSAIDs to prevent heart disease was 0.67 (95% CI, 0.38-1.13) for men and 0.43 (95% CI, 0.12-1.59) for women. For treating headache pain, the OR was 0.5 (95% CI, 0.23-1.09) for men and 0.64 (95% CI, 0.25-1.62) for women. The use of NSAID was not found to be associated with the stage of cancer at diagnosis. The OR for daily acetaminophen use was 1.07 (95% CI, 0.35-3.23) for men and 0.59 (95% CI, 0.27-1.25) for women. CONCLUSIONS: The regular use of NSAIDs was associated with an overall significant risk reduction of colorectal cancer in men and in women. Among female patients, the greater protective effect associated with short term NSAID use compared with long term NSAID use may reflect a sampling bias.

Acetaminophen↗
PubMed1994

Cancer mortality in Chinese immigrants to New York City. Comparison with Chinese in Tianjin and with United States-born whites.

BACKGROUND: Cancer rates in immigrant populations are frequently found to be intermediate between the country of origin and the adopted country. Such observations play an important role in establishing the environmental origin of cancer. Chinese now constitute the third largest group immigrating to New York City. METHODS: Cancer deaths in New York City (1986-90) among 706 male and 412 female foreign-born Chinese were compared using proportional cancer mortality ratios (PCMR) with Chinese who died of cancer in Tianjin, China (19,461 deaths, 1983-87), and with United States-born whites in New York City (32,293 deaths). RESULTS: Cancer sites were divided into those for which the age-adjusted PCMR were significantly higher in Tianjin Chinese (TC) compared with New York City whites (NYW), and those for which PCMR were significantly lower in TC compared with NYW. PCMR for Chinese immigrants usually fell between those of TC and NYW, but some were closer to those of TC (e.g., liver, gallbladder, female lung) whereas other sites were closer to those of NYW (e.g., esophagus, colon, rectum). CONCLUSIONS: These data provide additional support for the concept that much cancer originates with and can be modified by environmental factors.

China↗
PubMed1994

Assessment of chlorinated pesticides and polychlorinated biphenyls in adipose breast tissue using a supercritical fluid extraction method.

A precise and highly reproducible analytical method was developed for the assessment of organochlorinated pesticide and polychlorinated biphenyl residues in adipose tissue (> or = 50 mg). The method can be utilized for epidemiological studies on the significance of these environmental pollutants in the etiology of breast cancer. Supercritical fluid extraction (SFE) with CO2 and modified CO2 (addition of 5% dichloromethane) is employed to remove incurred pesticide residues from adipose tissues that have been surgically removed from breast cancer patients and controls. An alumina sorbent, placed in the extracting vessel together with a specimen, removes the bulk of co-extracted lipids; a subsequent purification of the SFE extracts by column chromatography on alumina removes the remaining traces of lipids that would interfere with the gas chromatographic analysis with electron capture detection. The method was tested by analyzing a Certified Reference Material 430 pork fat with known amounts of pesticide residues that are commonly found in fat or in foods with a high fat content. The recoveries of analytes ranged from 73.4% for endrin to 115% for alpha-, beta- and gamma-hexachlorocyclohexane, hexachlorobenzene and dieldrin, with standard deviations of 4-12% for individual analytes. The analysis of adipose tissue for organochlorinated compounds on the basis of this new method suggested that the pesticide levels were higher in breast cancer patients than in controls. However, the small number of samples analyzed in this study (n = 5, both groups) precludes definitive conclusions. The most abundant compounds in both cases and controls were p, p-DDE (379 +/- 286 and 160 +/- 149 p.p.b.) and PCB (223 +/- 145 and 124 +/- 65.7 p.p.b.), followed by the termiticide chlordane residues oxychlordane and transnonachlor.

Adipose Tissue↗