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S Harlap

Publications and source records attributed to S Harlap.

At least 37 records · Page 2Linked to original sources
PubMed1996

Case-control study of oral contraceptive use and risk of breast cancer.

The relation of oral contraceptive use to the risk of breast cancer in white women aged 25-59 years was assessed with data collected during 1977-1992 in a case-control surveillance system in hospitals in Boston, New York, and Philadelphia. A total of 3,540 cases with breast cancer were compared with 4,488 controls with nonmalignant nongynecologic conditions unrelated to oral contraceptive use. Relative risk estimates were obtained by unconditional logistic regression with control for major risk factors. For at least 1 year of use relative to less than 1 year, the multivariate relative risk estimate was 1.7 (95% confidence interval (CI) 1.3-2.3) in women aged 25-34 years, 0.9 (95% CI 0.7-1.0) in women aged 35-44 years, and 1.2 (95% CI 1.0-1.4) in women aged 45-59 years (p < 0.01 for the difference across age). Among women aged 25-34 years, the relative risk estimates were greatest for use of long duration, but the trend was not statistically significant (p = 0.17); in addition, the duration of use was correlated with the recency of use, and it was not possible to distinguish their effects. Among women aged 35-44 years, the relative risk estimate decreased with increasing duration of use (p = 0.01). Among women aged 45-59 years, some relative risk estimates were increased, but there was no consistent pattern. The results add to the evidence of an association between oral contraceptive use and an increased risk of breast cancer at young ages.

Adult↗
PubMed1996

Adenocarcinomas of the esophagus and gastric cardia: medical conditions, tobacco, alcohol, and socioeconomic factors.

Adenocarcinomas of the esophagus and gastric cardia have increased in incidence over the past 10-15 years in Western countries. The cause for this increase in incidence is still unknown. Our study was designed to investigate potential risk factors for adenocarcinomas of the esophagus and gastric cardia and to compare the risk profiles of a group of patients with this cancer with those having distal stomach cancer. We studied 95 incident cases with the pathological diagnosis of adenocarcinomas of the esophagus and gastric cardia, 67 patients with adenocarcinomas of the distal stomach, and 132 cancerfree controls. Patients were seen at Memorial Sloan-Kettering Cancer Center from November 1, 1992 to November 1, 1994. Epidemiological data were collected by a modified National Cancer Institute Health Habits History Questionnaire. Risk factors were analyzed using Mantel-Haenszel methods and a logistic regression model. Hypertension was associated with a 2-fold increased risk of adenocarcinomas of esophagus and gastric cardia after controlling for age, sex, race, education, pack-years of smoking, alcohol use, body mass index, and total dietary intake of calories. Increased risk of adenocarcinomas of esophagus and gastric cardia was associated with age, male gender, and Caucasian race. Tobacco smoking was related to a modest risk of adenocarcinomas of esophagus and gastric cardia. In contrast, the risk of distal stomach cancer was associated with stomach ulcers and pack-years of cigarette smoking. Iron deficiency was significantly associated with increased risk of both adenocarcinomas of the esophagus and gastric cardia and adenocarcinomas of the distal stomach. No obvious associations were identified for occupational exposures, family history of cancer, and physical activities. This study suggests that medical conditions such as hypertension and iron deficiency may be related to the risk of adenocarcinomas of esophagus and gastric cardia and confirms the moderate risk associated with tobacco smoking. Our results indicated an etiological heterogeneity with respect to risk factors identified between adenocarcinomas of esophagus and gastric cardia and those of the distal stomach.

Adenocarcinoma↗
PubMed1995

Relation of benzodiazepine use to the risk of selected cancers: breast, large bowel, malignant melanoma, lung, endometrium, ovary, non-Hodgkin's lymphoma, testis, Hodgkin's disease, thyroid, and liver.

Some animal data have raised the possibility that benzodiazepines influence the risk of selected cancers. With data collected in 1977-1991 in a US hospital-based study, the authors assessed the relation of benzodiazepine use to the risk of 11 cancers: breast (6,056 patients), large bowel (2,203), malignant melanoma (1,457), lung (1,365), endometrium (812), ovary (767), non-Hodgkin's lymphoma (382), testis (314), Hodgkin's disease (299), thyroid (111), and liver (37). Cases were compared with cancer controls (3,777 patients with other cancers) and noncancer controls (1,919 patients admitted for acute nonmalignant disorders). Relative risks were estimated for benzodiazepine use at least 4 days a week for at least 1 month, initiated at least 2 years before admission (sustained use) by multiple logistic regression with control for confounding factors. Results derived with noncancer controls were similar to those derived with cancer controls. For sustained benzodiazepine use relative to no use, relative risk estimates for all 11 cancers were compatible with 1.0 at the 0.05 level of significance. Relative risk estimates for durations of at least 5 years were also compatible with 1.0, with the exceptions of an increased estimate, of borderline statistical significance, for endometrial cancer, and a decreased estimate for ovarian cancer. Relative risk estimates both for sustained use that continued into the 2-year period before admission and for sustained use that ended up to > or = 10 years previously were compatible with 1.0, suggesting a lack of tumor promotion and no increase in the risk after a latent interval. Results were also null for diazepam, chlordiazepoxide, and other benzodiazepines considered separately. The results suggest absence of association between benzodiazepine use and the cancers considered, with the evidence stronger for the cancers with larger numbers of subjects. The similarity of results derived with cancer and noncancer controls suggests that benzodiazepines do not influence the risk of cancer as a whole.

Adolescent↗
PubMed1995

Adult height and risk of breast cancer among US black women.

Adult height has been positively associated with the risk of breast cancer in a number of recent investigations. The authors assessed height in relation to breast cancer risk in a case-control study of US black women aged 25-69 years; 674 hospital patients with newly diagnosed breast cancer and 1,155 controls hospitalized for nonmalignant conditions unrelated to height were interviewed. After control for multiple confounders, the relative risk estimate for women < 61 inches (< 154.9 cm) tall was 0.5 (95% confidence interval (Cl) 0.3-0.7) relative to the median height of 64-65 inches (162.6-165.1 cm). Among women > or = 61 inches (> or = 154.9 cm) tall, there was little indication of any variation in risk with increasing height. The findings suggest that short stature is associated with a decreased risk of breast cancer in US black women.

Adult↗
PubMed1995

Oral contraceptive use and breast cancer risk among African-American women.

Recent epidemiologic studies, most of them in predominantly White populations, have suggested that long duration of oral contraceptive (OC) use may increase the risk of breast cancer at young ages. We assessed the relationship of OC use to the risk of breast cancer in African-American women aged 25 to 59 years, using interview data from a multipurpose hospital-based case-control study. Five hundred and twenty-four cases hospitalized for invasive breast cancer were compared with 1,021 controls with nonmalignant conditions unrelated to OC use. Relative risks (RR) and 95 percent confidence intervals (CI) were estimated relative to a reference category of use for less than 12 months; potential confounders were controlled by multiple logistic regression analysis. Among women under age 45, three or more years of OC use was associated with an increased risk of breast cancer: the RR estimate was 2.8 (CI = 1.5-5.0) for three to four years of use, and declined to 1.5 (CI = 08.3.0) for 10 or more years of use. Recency and timing of use did not explain the observed association. Among women aged 45 to 59, OC use was associated with little or no increase in risk: the RR estimate for three or more years of use was 1.3 (CI = 0.7-2.4). The findings add to the evidence from studies of White women and a recent study of Black women which have suggested an increased risk of breast cancer at young ages for moderate or long duration use of OCs.

Adult↗
PubMed1994

The relation of vasectomy to the risk of cancer.

We previously reported a strong positive association between vasectomy and the risk of prostatic cancer that arose in multiple comparisons made within data collected from 1976 to 1988 in an ongoing hospital-based surveillance study of many exposures and diseases. We have reassessed this association with data collected in the surveillance study during 1988-1992 from a new set of patients (355 cases of prostatic cancer and 2,048 controls with nonmalignant conditions). Because some studies have reported increased relative risks of lung cancer and testicular cancer in vasectomized men, we also used the surveillance database (4,126 men with various cancers, 7,027 men with nonmalignant conditions) to assess the relation of vasectomy to the risk of these and other cancers. In the newly collected data, the multivariate relative risk estimate for prostatic cancer in vasectomized men was 1.2 (95% confidence interval (CI) 0.6-2.7). For lung cancer and testicular cancer, the relative risk estimates were 1.3 (95% CI 0.8-2.1) and 0.8 (95% CI 0.4-1.9), respectively; for lung cancer occurring > or = 15 years after vasectomy, the relative risk estimate was 1.9 but it was not statistically significant (95% CI 0.7-5.0). For pancreatic cancer, the relative risk estimate was 1.8 (95% CI 1.0-3.1). For each of the other cancers considered--malignant melanoma, large bowel cancer, bladder cancer, kidney cancer, lymphoma, leukemia, and other cancers--the relative risk estimate was 1.3 or less and compatible with a value of 1.0. The present data provide little support for an association of vasectomy with the risk of prostatic cancer or other cancers. In addition, the data from two sets of cases of prostatic cancer and controls interviewed consecutively illustrate that increased relative risks detected in screening for statistically significant associations may tend to have an upward bias and to be lower in subsequent data.

Adult↗
PubMed1994

A case-control study of oral contraceptive use and invasive epithelial ovarian cancer.

The relation of oral contraceptive use to the risk of ovarian cancer was assessed with data collected during 1977-1991 from patients under 65 years of age in hospitals in Boston, New York, Philadelphia, and Baltimore. We compared 441 women with recently diagnosed invasive epithelial ovarian cancer to 2,065 control women. Logistic regression was used to control risk factors for ovarian cancer. The multivariate relative risk estimate decreased with the increasing duration of oral contraceptive use (p < 0.05): the estimate was close to 1.0 for duration categories of less than 3 years; it was reduced for the categories of 3-4 years of use and greater, but it did not decline further as the duration of use increased. For > or = 3 years of use, the estimate was 0.6 (95% confidence interval 0.4-0.8). The inverse association of risk with > or = 3 years of use was consistently present across categories of age, parity, interview year, and geographic area. It was apparent for as long as 15-19 years after cessation. Many different specific oral contraceptive formulations appeared related to a decreased risk; however, data were sparse for the newer types, particularly phasic preparations, and the ability to assess specific preparations in the context of use of multiple preparations was limited. The present data confirm previous reports of an inverse association of ovarian cancer risk with oral contraceptive use of several years in duration. They also suggest that the association may persist for as long as two decades and that it is not confined to any particular type of oral contraceptive formulation.

Adult↗
PubMed1994

Breast feeding in Israel: maternal factors associated with choice and duration.

STUDY OBJECTIVES: To determine the influence of maternal characteristics on the incidence and duration of breast feeding. DESIGN: All the women who delivered in three obstetric wards within a two year period were surveyed. These three wards cover 93% of all births in the Jerusalem district. Women were interviewed on breast feeding of the previous child on the first or second day post partum by a research nurse. PARTICIPANTS: Altogether 8486 women whose previous pregnancy had resulted in a live born singleton who survived for at least one year. MEASUREMENTS AND MAIN RESULTS: Breast feeding information was linked to demographic and health information from hospital records. Using logistic regression analysis, failure to start breast feeding was best predicted (p < 0.001) by caesarean delivery, infant's birth weight, maternal smoking habits, and mother being non-immigrant. Maternal age (< 24 or > 40 years) and father being an ultraorthodox Jew were also positively (p < 0.05) associated with the decision to breast feed. Long term breast feeding (three months or more) was strongly affected (p < 0.001) by maternal education level, with both women with the fewest and the greatest number of years of schooling more likely to breast feed. A similar association was observed in all ethnic groups. Primipara and grandmultipara (parity > 4), new immigrants, ultraorthodox Jews, and non-smokers breast fed their babies for longer. CONCLUSIONS: The importance of maternal characteristics in relation to breast feeding was shown. Caesarean delivery and the infant's birth weight were strongly related to the decision to breast feed as were the demographic characteristics of mother's age and her country of birth. Education was not related to this decision but was strongly associated with the duration of breast feeding, as was parity. The behavioural characteristics of smoking and being ultraorthodox were related to both the decision to start and the duration of breast feeding. Efforts to encourage breast feeding ought to be targeted during the hospital stay and post partum period towards women identified as being at increased risk.

Adult↗
PubMed1992

Oral contraceptive use and risk of cutaneous malignant melanoma.

The relation between cutaneous malignant melanoma (MM) and the use of oral contraceptives (OC) was investigated in a case-control study carried out from 1979 to 1991 among patients in hospitals and clinics in the Philadelphia (PA) and New York City (NY) metropolitan areas (United States). Cases were 615 women under age 70 who recently had been diagnosed with invasive melanoma; controls were 2,107 women of the same ages who had been treated for other conditions unrelated either to OC use or to skin diseases. The cases were categorized as severe or nonsevere based on the depth of invasion of the tumor or the presence or absence of metastases. Among the severe cases, OC use was not associated with MM: the relative risk (RR) estimate for ever-use was 1.1 (95 percent confidence interval [CI] = 0.8-1.5) and the estimate for 10 or more years of use was 1.1 (CI = 0.6-2.1). Nor was risk associated with recent use, long latency, or young age at first use. Among the nonsevere cases, ever-use of oral contraceptives was associated positively with MM (RR = 1.5, CI = 1.1-2.4) but there was no trend with increased duration of use. The findings provide evidence against the hypothesis that OC use increases the risk of malignant melanoma. The elevated estimates among the nonsevere cases most likely reflect selection bias rather than a causal relation.

Adolescent↗
PubMed1992

The benefits and risks of hormone replacement therapy: an epidemiologic overview.

In postmenopausal women estrogens alone are effective in reversing vasomotor symptoms and vaginal atrophy. They also prevent the bone loss associated with osteoporosis and reduce the risk of cardiovascular disease, probably through their beneficial effects on lipid metabolism. Unopposed long-term estrogen therapy, however, increases the risk of developing endometrial hyperplasia, endometrial cancer, and possibly breast cancer as well. The risk of developing endometrial cancer can be reduced by combining a progestin with the estrogen, by controlling obesity, and by rigorous clinical screening and surveillance. The effect of progestins on the risk of developing breast cancer is still controversial. Although some progestins may reverse the cardioprotective effect of estrogens, those with minimal androgenicity appear less likely to do so. Hormone replacement therapy that combines estrogen with a progestin of minimal androgenicity is thus a rational alternative to unopposed estrogen therapy. Current epidemiologic knowledge suggests that the benefits of hormone replacement therapy, with or without any progestins, strongly outweigh the risks.

Breast Neoplasms↗
PubMed1991

Prevention strategy of hepatitis B virus infection among the Ethiopian community in Israel.

Between 1980 and 1985, over 16,000 immigrants from Ethiopia, a population at high risk for hepatitis B virus (HBV) infection, arrived in Israel. The present study was designed to provide epidemiological information necessary for developing prevention strategies against HBV infection. Among the 144 subjects studied in an absorption center in Israel, only 32% had no detectable HBV markers and were therefore susceptible to infection. The prevalence rate of HBsAg was 19% compared with 42% for anti-HBs and 7.6% for anti-HBc alone. The percentage of subjects with no HBV marker decreased sharply with age, and there was similarly an age-linked increase in anti-HBs, indicating the importance of horizontal transmission in HBV infection. The distribution of HBV markers was similar in both sexes. Evidence of mild liver disease was found in only three subjects. All newborns and new arrivals less than 2 years of age in the Ethiopian community are vaccinated against HBV infection to prevent vertical and early horizontal transmission. The data obtained in our study suggest that this means of prevention of HBV infection is insufficient. We suggest that the vaccination of all children aged 2-7 without prevaccination screening, and the vaccination of children aged 8-18 found to be susceptible on anti-HBc screening, would substantially lower HBV transmission in this community.

Adolescent↗
PubMed1991

Oral contraceptives and breast cancer. Cause and effect?

Case-control studies dealing with breast cancer and oral contraceptives (OCs) were reviewed against a background of currently accepted rules for conducting and interpreting epidemiologic research. There is a strong consensus that OCs have not increased the risk of breast cancer in women over age 45, even when they have been used for long periods. The controversy is confined to studies of cancer diagnosed in young women. Although an effect of duration of OC use has been observed in some studies, there is neither a latency period nor an effect from recent or current use. There is no obvious relationship to the type of pill and no consistent effect of the dose of estrogen. The effect, if it exists at all, is not confined to any specific subgroup; it has not been related to age at starting OCs. It has been observed in only a few studies, some of which were subsequently discounted. Others have shown no effect or have suggested a reduced risk of breast cancer with increasing duration of use. None of the studies purporting to show an effect of OCs have controlled for the potential confounding effects of duration of lactation, induced abortion, recent pregnancy or a history of diseases that are associated both with reduced use of OCs and reduced risk of breast cancer. Most have inappropriately controlled for benign breast disease. There is an urgent need for a reanalysis of existing studies to take these factors into account. The lack of consistency and the potential for bias and confounding argue strongly against concluding, at this time, that there is a causal relationship between OCs and breast cancer.

Abortion, Spontaneous↗
PubMed1990

A cohort analysis of cervical cancer in Israeli Jewish women.

The incidence of squamous cell cervical cancer was studied in Jewish Israeli women between 1961 and 1981. The 1052 cases and the 27,832,272 women-years of observation were divided according to continent-of-origin, year-of-birth, and immigration-wave cohorts. Age-adjusted odds ratios were calculated for each cohort and compared. The incidence of cervical cancer was shown to have changed according to cohort year of birth, most significantly in women born in Europe and America. The highest risk in this group was seen in women born in 1891-1895 and 1941-1945 and the lowest in women born between 1926 and 1935. A high risk was also observed in all cohorts of North African women. There was a sharp rise in risk for women of all origins born after 1940. Immigration to Israel at a younger age was correlated with reduced risk for cervical cancer. It has been shown that epidemics of sexually transmitted diseases (STDs) are followed in time by epidemics of cervical cancer. Since there was an epidemic of STDs in Israel between 1967 and 1970, our results also suggest that there is a rise in the risk for cervical cancer in women who were sexually active during the epidemic of STDs. Because of the low rates for cervical cancer traditionally observed in Israeli women, routine screening was not done in Israel in the past. Should the relative risk for cervical cancer in women exposed during the 1967-1970 epidemic continue to be high, screening may prove worthwhile.

Adult↗
PubMed1990

Health, growth and sexual development of teenagers exposed in utero to medroxyprogesterone acetate.

General health, growth and sexual development were evaluated in 74 teenage boys and 98 girls who had been exposed to medroxyprogesterone acetate (MPA) in utero, and 385 boys and 448 girls not exposed. In this 17-year prospective study, the ascertainment of the end points was 'double blind' in that neither the interviewer nor the subject was aware of our interest in MPA. On average, girls exposed to MPA reported reaching the menarche 4 months earlier than the comparison group. This difference disappeared, however, in a multiple regression analysis taking into account social class, the mother's age at menarche and height of the girl's mother and father. Boys exposed to MPA reported their growth spurt to have occurred an average of 6 months earlier and voices to have broken 5 months earlier than unexposed boys. Again, the differences between them and the comparison group disappeared after controlling for confounding variables. There were no significant differences between the MPA-exposed and comparison groups in a wide variety of indices of health reported by the teenagers' mothers. These findings are consistent with the hypothesis that intrauterine exposure to MPA, in the doses used for pregnancy maintenance or for contraception, poses no threat to the long-term health and development of the progeny.

Adolescent↗
PubMed1989

Aggression, physical activity levels and sex role identity in teenagers exposed in utero to MPA.

Sex-dimorphic traits and behavior were measured in a 17-year old prospective study of 74 teenager boys and 98 girls who had been exposed to medroxyprogesterone acetate in utero compared with 459 boys and 546 girls not exposed. Bem Sex Role Identity scores were identical in exposed and non-exposed teenagers of each sex. There were no significant differences between MPA-exposed and non-exposed males or females on the Buss-Durkee overall aggression scale and on its assaultiveness subscale. Mothers of exposed males more often reported that teachers had complained that their offspring were naughty in school. No such difference was reported for females, nor for other school behaviors of dominance/aggression, activity, shyness and quietness. Exposed and non-exposed children were similar in the number of accidents experienced in childhood, as reported by their mothers, and in participation in competitive sports. These findings fail to support hypotheses posed by earlier researchers that exposure in utero to medroxyprogesterone acetate might alter sex-dimorphic behavior or traits in later life.

Adolescent↗