Biomedical subjects

W C Hunt

Publications and source records attributed to W C Hunt.

At least 55 records · Page 3Linked to original sources

PubMed1996

Short-term fluctuations in the detection of cervical human papillomavirus DNA.

OBJECTIVE: To obtain point and cumulative prevalence estimates of cervical human papillomavirus (HPV) infection using two HPV DNA detection methods with different end point sensitivities; compare cervical swab and cervicovaginal lavage specimen collection methods for subsequent evaluation by polymerase chain reaction (PCR); and evaluate potential effects of the menstrual cycle on HPV DNA detection. METHODS: Seventy-two college women participated in a 10-week follow-up study. Cervical samples were obtained for HPV DNA detection and typing at each clinic visit, and information was collected concerning menstrual cycle and sexual and hygienic behaviors. Human papillomavirus DNA was detected by the ViraPap HPV DNA dot-blot assay and a broad-spectrum PCR HPV DNA amplification system. RESULTS: On a weekly basis, point prevalence for HPV infection by the ViraPap assay ranged from 4.2 to 9.7%, and the cumulative prevalence was 13.9%. Point prevalence by the broad-spectrum PCR assay ranged from 20.8 to 47.2%, and the cumulative HPV prevalence was 58.3%. Using cervicovaginal lavage specimens, we found lower cervical HPV prevalence estimates when compared with cervical swab specimens in the HPV PCR-based assay. No correlation between HPV DNA detection and phase of menstrual cycle was observed. CONCLUSION: Short-term HPV DNA detection is highly variable within individuals; therefore, single-point measurements of cervical HPV have limitations when assessing an individual's HPV status. The relationship between short-term and long-term HPV DNA persistence profiles may prove relevant to determining the risk of developing cervical intraepithelial neoplasia.

Adult↗

PubMed1996

Regional variation in survival following the diagnosis of cancer.

Recent studies have documented substantial geographical variation in patterns of treatment of cancer and other diseases. Because cancer treatment is not uniform nationwide, survival following the diagnosis of cancer might also be expected to vary geographically. Survival data from the nine population-based registries in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program were analyzed for cancers of the stomach, colon, rectum, lung, breast, uterus, ovary, prostate, and bladder (n = 401,861). The patients included all non-Hispanic white patients diagnosed with cancer of one of the selected sites during 1983-1991. Regional variation in crude five-year survival rates across the nine SEER areas was most marked for cancers of the uterus and prostate. For uterine cancer, for example, five-year survival ranged from 73.2% in Connecticut to 84.0% in Hawaii. Less marked variation was observed for cancers of the colon, rectum, and breast. For cancers of the bladder, ovary, stomach, and lung, survival rates five years after diagnosis were relatively invariant across the SEER areas. Observed differences in survival rates, although statistically significant, were relatively modest from the standpoint of the practicing physician. Nonetheless, the general pattern of regional variation was unchanged after adjustment for sex, age, stage, and surgical treatment and when analysis was limited to patients younger than 70 years, who would be anticipated to have the least comorbidity.

Demography↗

PubMed1996

Improving survival for patients with prostate cancer diagnosed in the prostate-specific antigen ERA.

OBJECTIVES: Although prostate-specific antigen (PSA) screening has not been demonstrated to reduce prostate cancer mortality in the clinical trial or population setting, the use of PSA for screening increased during the early 1990's. A clinical trial is currently underway to test the efficacy of PSA screening; however, the results will not be available for at least 10 years. To address concerns about the effectiveness of PSA screening in the near term, population-based assessments of PSA screenings are needed. To reduce mortality, PSA screening must first produce improved survival. In New Mexico, increased screening was associated with a stage migration from distant to earlier stages and an increase in 5-year relative survival, suggesting that PSA screening may be effective. METHODS: To further investigate early indicators of the effectiveness of PSA screening in New Mexico, we examined temporal trends in survival for the period 1983-1992, using proportional-hazard models to estimate the risk of death by year of diagnosis, adjusted for age, stage, grade, ethnicity, and initial treatment. RESULTS: We found the risk of death following the diagnosis of local or regional-stage prostate cancer decreased in the 1987-1988 (relative-risk [RR] = 0.9 [95% confidence interval (CI) 0.8, 1.1]), 1989-1990 [RR = 0.9 [0.8, 1.0]), and 1991-1992 (RR =0.7 [0.6, 0.9]) periods compared with the 1983-1984 period. Men treated with radical prostatectomy were at increased risk between 1985 and 1990, compared with those treated in the 1983-1984 period. However, for men diagnosed and treated in the 1991-1992 period, risks were lower than in the 1983-1984 period (RR =0.8 [0.4, 1.5]). CONCLUSIONS: The earlier stage at diagnosis and the improved survival during the period of increased PSA screening are consistent with changes expected from an effective screening test and treatment modality.

Age Distribution↗

PubMed1996

A randomized, double-blind comparison of donor tolerance of 400 mL, 200 mL, and sham red cell donation.

BACKGROUND: Volume replacement could allow the safe collection of twice the normal amount of red cells in a standard donation. Studies in small numbers of donors have shown that a temporary decrease in red cell mass is well tolerated when donors give twice the usual amount (170-225 mL) of red cells in a standard 405- to 495-mL donation. Sham-donation control groups have not been included in previous studies of increased red cell donation, and perceptions of donation effects could have been biased. STUDY DESIGN AND METHODS: In the study reported here, 17 male and 13 female volunteers were randomly assigned to make a sham donation, 1-unit donation, or 2-unit donation on an automated blood cell separator. Donor tolerance was assessed by ambulatory heart rate monitoring and by a poststudy interview. Hemoglobin, hematocrit, ferritin, serum iron, total iron-binding capacity, red cell 2,3 DPG, and serum erythropoietin were measured before and after donation for comparison of the erythropoietic responses in the three study groups. RESULTS: Red cells collected totaled 206 +/- 10 mL in the 1-unit group and 414 +/- 21 mL in the 2-unit group. Changes in heart rate, systolic blood pressure, and diastolic blood pressure with donation and changes in heart rate recorded by ambulatory monitoring did not differ for the experimental groups. Postdonation changes from baseline values were evaluated on Days 2, 7, and 14. Changes in hemoglobin were significantly different between groups (p < 0.017) in all postdonation tests. There were differences between groups in erythropoietin response, red cell 2,3 DPG, ferritin levels, and hemoglobin synthesis. Hemoglobin synthesis and mean changes in 2,3 DPG, erythropoietin, ferritin, and postdonation hemoglobin were greater in the 2-unit group than in the 1-unit group. CONCLUSION: Donor tolerance of red cell donations of 414 +/- 21 mL, a volume of red cells twice that in a standard 450-mL blood donation, does not differ from donor tolerance of standard or sham donations. Physiologic adjustments and the hematopoietic response to reduced red cell mass were greater in the 2-unit group, but the donation of 1 unit or 2 units did not cause detectable symptoms of reduced oxygen-carrying capacity.

Blood Donors↗

PubMed1996

Temporal and regional variability in the surgical treatment of cancer among older people.

OBJECTIVES: Numerous studies have documented that older individuals with cancer have been treated less aggressively than younger individuals. We utilized data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program to assess geographic variation in the effects of age on the surgical treatment of cancer and to examine temporal trends in the treatment of older people between 1973 and 1991. DESIGN: Ecological analyses comparing time trends of treatment in nine regions over a 19-year period. SETTING: Population-based data for nine geographic areas of the United States. PARTICIPANTS: Persons with incident cancer of the breast, colon, rectum, lung, ovary, uterus, pancreas, and stomach residing in these regions during the selected years. RESULTS: After age 64, the percentage of patients treated surgically decreased with increasing age for every cancer site studied. Between 1973 and 1991, the likelihood of receiving surgery for cancers of the uterus, colon, rectum, ovary, and breast increased more rapidly among patients ages 65 years and older than among those under age 65. This relative increase occurred consistently across most geographic areas studied. For cancers of the lung, stomach, and pancreas, the effect of age on the likelihood of receiving surgery did not diminish through the period under study.: CONCLUSIONS: Although older people remain less likely to receive surgical therapy than younger persons, for some important cancer sites the gap between the treatment of older and younger individuals narrowed from 1973 through 1991.

Age Factors↗

PubMed1996

Ethnic variation in prostate cancer survival in New Mexico.

Prostate cancer survival varies markedly by ethnicity. American Indians and blacks have the lowest 5-year relative survival among ethnic groups in the U.S. In New Mexico, relative survival for prostate cancer is lower for ethnic minority groups than for non-Hispanic whites. To examine factors underlying ethnic differences in prostate cancer survival in New Mexico, we analyzed Surveillance, Epidemiology, and End Results Program data collected by the New Mexico Tumor Registry from 1983 to 1992. Unadjusted relative risk (RR) of death after prostate cancer diagnosis was greater for Hispanics [RR = 1.1; 95% confidence interval (CI), 1.0, 1.2], American Indians (RR = 1.4; 95% CI, 1.2, 1.5), and blacks (RR = 1.5; 95% CI, 1.2, 1.7) than for non-Hispanic whites. After adjusting for age, stage, histological grade, year of diagnosis, and initial treatment, the risk for Hispanics (RR = 1.0; 95% CI, 0.9, 1.1), American Indians (RR = 1.0; 95% CI, 0.9, 1.1), and non-Hispanic whites was comparable. Although based on small numbers, adjusted risk ratios among blacks remained elevated (RR = 1.2; 95% CI, 0.9, 1.6), due in part to lower survival during the first 12 months after diagnosis (RR = 2.0; 95% CI, 1.2, 3.3) and poorer survival following radical prostatectomy (RR = 4.2; 95% CI, 1.3, 13). These findings suggest that poorer survival for Hispanics and American Indians may be explained by delayed detection and differences in treatment.

Aged↗

PubMed1996

Breast cancer survival among New Mexico Hispanic, American Indian, and non-Hispanic white women (1973-1992).

A study of breast cancer survival was conducted among New Mexico Hispanic and non-Hispanic white women and New Mexico and Arizona American Indian women diagnosed between 1973 and 1992. The goals were to determine whether, after adjusting for first treatment and the extent of disease at diagnosis, American Indian and Hispanic women had poorer survival than non-Hispanic whites and, if survival had improved over time, whether comparable improvements had been made for the three racial/ethnic groups. Five-year relative survival rates were calculated, and a Cox proportional hazards model was constructed to compare survival between races/ethnicities, adjusting for first treatment and the extent of disease at diagnosis. Findings indicate that during 1983-1992, breast cancer was more commonly detected at a local stage for all three groups compared to 1973-1982. Five-year relative survival improved for non-Hispanic white and American Indian women with local or regional disease, but the improvement was statistically significant only for non-Hispanic white women and for American Indian women with local disease. Despite earlier stages at diagnosis, Hispanic females showed less improvement in overall or stage-specific survival than non-Hispanic whites. The Cox model indicated that American Indian women experienced poorer survival than non-Hispanic whites during both time periods. Survival of Hispanic women with breast cancer was comparable to non-Hispanic whites during 1973-1982 but was significantly worse during 1983-1992. The significance of this lower survival is amplified by increasing breast cancer incidence among New Mexico Hispanics and American Indians.

Breast Neoplasms↗

PubMed1995

Biased comparisons of lung cancer survival across geographic areas: effects of stage bias.

This report illustrates bias that may affect comparative analyses of cancer survival across geographic areas and describes how it limits the conclusions that can be drawn from such data. Despite the application of a standardized procedure for assigning tumor stage, patients from different areas who are assigned the same stage category may not be homogeneous with respect to extent of disease, if staging is accomplished more aggressively in one group than in another. Stage-specific comparisons of survival may be biased as a result. Cancer sites for which a large majority of patients are treated surgically may be less susceptible to stage bias.

Aged↗

PubMed1994

Determinants of receiving breast-conserving surgery. The Surveillance, Epidemiology, and End Results Program, 1983-1986.

BACKGROUND: Although breast-conserving surgery was used with increasing frequency during the 1980s for management of breast cancer, most women still undergo mastectomy, and a substantial variation has been documented in the proportion of women receiving breast-conserving surgery across regions of the country. Using data from the Surveillance, Epidemiology, and End Results (SEER) Program for 1983-1986, we assessed characteristics of the county of residence as predictors of receipt of breast-conserving surgery and determined whether regional variation persisted after considering these characteristics. METHODS: The data used involved all 19,661 non-Hispanic white women with localized breast cancer diagnosed in 1983 through 1986 in the nine SEER regions. Information on county characteristics was obtained from standard sources and merged with the SEER data. Univariate multivariate statistical methods were used to assess the effects of county characteristics on type of surgery for breast cancer. RESULTS: As anticipated, age was a strong predictor of type of surgery. In analyses that controlled for age, county characteristics that significantly predicted receipt of breast-conserving surgery included physician-to-population ratio, education and income levels, the presence of cancer center, and the presence of a city of at least 100,000. After controlling for these factors using multiple logistic regression, substantial regional variation persisted. CONCLUSIONS: Regional variation in treatment of localized breast cancer across the SEER regions is not explained by patient's age or county characteristics. Research is needed to address the decision making of individual patients and their physicians regarding type of surgery.

Aged↗

PubMed1994

Silicosis and lung cancer risk in underground uranium miners.

The presence of radiographic silicosis as a risk factor for lung cancer was assessed in a case-control study conducted within a study cohort of New Mexico underground uranium miners. Chest radiographs were interpreted for the presence of silicosis for 65 lung cancer cases and 216 controls. The presence of silicosis on the chest radiograph taken closest to the start of employment or on the latest radiograph available was not associated with lung cancer risk after adjustment for cumulative exposure to radon progeny. The odds ratio associated with the presence of any type of opacity indicative of pneumoconiosis on the chest x ray closest to the start of employment was 1.33 (95% confidence interval, 0.31-5.72). For the most recent available chest x ray, the corresponding odds ratio was 1.16 (95% confidence interval, 0.35-3.84). Although the findings are limited by the relatively small number of subjects, the lack of association of silicosis with lung cancer suggests that silica exposure should not be regarded as a major uncertainty in extrapolating radon risk estimates from miners to the general population.

Case-Control Studies↗

PubMed1994

Nitrogen dioxide and respiratory illness in children. Part III: Quality assurance in an epidemiologic study.

This report describes the quality assurance and quality control program developed for the previously reported epidemiologic study of nitrogen dioxide (NO2) and respiratory illness in children (Health Effects Institute Research Report 58, Parts I and II). The specific aims of the program were to make certain that data were sufficiently accurate, complete, verifiable, and retrievable. The quality assurance and quality control program consisted of: a written protocol, standard operating procedures, written records, a project management system, appropriate data processing, data verification, and data analysis planning, and was staffed by qualified and appropriately trained personnel. Within the activities of the overall program, two focused quality assurance studies were conducted. During the first of these focused studies, parents maintained a calendar-diary of their child's daily respiratory symptoms. Telephone interviews were conducted at intervals of two weeks, and parents used the calendars to report on symptom occurrence since the previous call. To assess the comparability of illness events based on symptom reports from the parents with usual clinical diagnostic methods, nurse practitioners examined children during illness, and office and clinic records of outpatient visits were reviewed. Using the parent reports, respiratory illnesses were defined as symptom episodes of at least two consecutive days; lower respiratory illnesses included at least one day of either wet cough or wheeze. Runny or stuffy nose was reported for 93% of illnesses; and wet cough for 33% and wheeze for 6% of illnesses. In comparison with the diagnoses made by a nurse practitioner, parent reports of wet cough or wheeze were sensitive (93.4%) for detecting lower respiratory illnesses, but nonspecific (with specificity of only 24.2%). The majority of the false-positive lower respiratory illnesses had the symptom of wet cough. The comparison of parent reports with outpatient records provided similar findings. These findings indicate that standardized reporting of respiratory illnesses can be achieved with regular telephone interviews, but the classification of specific illnesses from the observations of parents' information may differ from diagnoses made by clinicians. The second focused quality assurance study evaluated the measurement error associated with the parents' use of passive diffusion samplers for NO2. Midway through the study, technicians conducted home visits to assess compliance with stated procedures, and to make independent measurements of NO2. Based on criteria for placement and use of the samplers, conditions of noncompliance were observed on about 40% of visits.(ABSTRACT TRUNCATED AT 400 WORDS)

Data Collection↗

PubMed1993

Determinants of cancer therapy in elderly patients.

BACKGROUND: Older patients with cancer are less likely to receive definitive therapy, but the reasons for this are unclear. METHODS: All people aged 65 years or older living in six counties in New Mexico and diagnosed with breast, prostate, or colorectal cancer between May 15, 1984 and May 15, 1986 (N = 669) were interviewed to obtain information on demographics, socioeconomic status, functional status, social support, other medical conditions, and cognitive status. Cancer treatment information was obtained from the New Mexico Tumor Registry. RESULTS: In univariate analyses, the following variables were associated significantly with nonreceipt of definitive therapy for cancer: advanced age, impairment in activities of daily living, low physical activity, decreased mental status, impaired access to transportation, and poor social support. In a multivariate analysis with the above variables along with measures of comorbidity, only advanced age and decreased mental status remained significant predictors of nonreceipt of definitive surgery, whereas the effects of impaired access to transportation and low physical activity remained relatively large but no longer were statistically significant. When receipt of surgery and receipt of radiation therapy were considered separately, older age, limited access to transportation, impaired functional status, and impaired mental status all significantly predicted nonreceipt of radiation therapy, but not surgery. CONCLUSIONS: There is a decline with age in the percentage of adults with cancer who received definitive therapy independent of other potentially explanatory factors such as comorbidity. In addition, decisions about radiation may be influenced by nonmedical, potentially correctable factors such as impaired access to transportation.

Activities of Daily Living↗

PubMed1993

Comparability of parent reports of respiratory illnesses with clinical diagnoses in infants.

In a cohort study of respiratory illnesses from birth through age 18 months, the investigators assessed the occurrence of illness by telephone reports of respiratory symptoms. To assess the comparability of illness events based on symptom reports with usual clinical modalities, a nurse practitioner examined children during illnesses, and office and clinic records of outpatient visits were reviewed. Respiratory illnesses were defined as symptom episodes of at least 2 days; lower respiratory illnesses included at least 1 day of either wet cough or wheeze. This report is based on 10,771 illnesses in the 1,315 subjects enrolled. Runny or stuffy nose was reported for most (93%) illnesses, wet cough in 33%, and wheeze in 6%. In comparison with the diagnoses made by a nurse practitioner, parent report of wet cough or wheeze was sensitive (93.4%) for detecting lower respiratory illnesses, but nonspecific with specificity of only 24.2%. The majority of the false-positive lower respiratory illnesses had the symptom of wet cough. The comparison of parent reports with outpatient records provided similar findings. Standardized reporting of respiratory illnesses can be achieved with a telephone surveillance system but classification of specific illnesses from the surveillance information may differ from diagnoses made by clinicians.

Cohort Studies↗

PubMed1993

Nitrogen dioxide and respiratory illnesses in infants.

Nitrogen dioxide is an oxidant gas that contaminates outdoor air and indoor air in homes with unvented gas appliances. A prospective cohort study was carried out to test the hypothesis that residential exposure to NO2 increases incidence and severity of respiratory illnesses during the first 18 months of life. A cohort of 1,205 healthy infants from homes without smokers was enrolled. The daily occurrence of respiratory symptoms and illnesses was reported by the mothers every 2 wk. Illnesses with wheezing or wet cough were classified as lower respiratory tract. Indoor NO2 concentrations were serially measured with passive samplers place in the subjects' bedrooms. In stratified analyses, illness incidence rates did not consistently increase with exposure to NO2 or stove type. In multivariate analyses that adjusted for potential confounding factors, odds ratios were not significantly elevated for current or lagged NO2 exposures, or stove type. Illness duration, a measure of illness severity, was not associated with NO2 exposure. The findings can be extended to homes with gas stoves in regions of the United States where the outdoor air is not heavily polluted by NO2.

Air Pollutants↗

PubMed1993

Nitrogen dioxide and respiratory illness in children. Part I: Health outcomes.

We have carried out a prospective cohort study to test the hypothesis that exposure to nitrogen dioxide increases the incidence and severity of respiratory infections during the first 18 months of life. Between January 1988 and June 1990, 1,315 infants were enrolled into the study at birth and followed with prospective surveillance for the occurrence of respiratory infections and monitoring of nitrogen dioxide concentrations in their homes. The subjects were healthy infants from homes without smokers; they were selected with stratification by type of cooking stove at a ratio of four to one for gas and electric stoves. Illness experience was monitored by a daily diary of symptoms completed by the mother and a telephone interview conducted every two weeks. Illnesses with wheezing or wet cough were classified as involving the lower respiratory tract; all other respiratory illnesses were designated as involving the upper respiratory tract. Exposure to nitrogen dioxide was estimated by two-week average concentrations measured in the subjects' bedrooms with passive samplers. This analysis is limited to the 1,205 subjects completing at least one month of observation; of these, 823 completed the full protocol, contributing 82.8% of the total number of days during which the subjects were under observation. Incidence rates for all respiratory illnesses, all upper respiratory illness, all lower respiratory illnesses, and lower respiratory illness further divided into those with any wheezing, or wet cough without wheezing, were examined within strata of nitrogen dioxide exposure at the time of the illness, nitrogen dioxide exposure during the prior month, and type of cooking stove. Consistent trends of increasing illness incidence rates with increasing exposure to nitrogen dioxide were not evident for either the lagged or unlagged exposure variables. The effect of nitrogen dioxide exposure on illness occurrence during at-risk intervals of two weeks' duration was examined using the generalized estimating equation approach. In these multivariate analyses, none of the odds ratios was significantly elevated for unlagged nitrogen dioxide exposures, lagged nitrogen dioxide exposures, or stove type. Duration of illness was assessed in relation to the same exposure variables; illness duration and nitrogen dioxide exposure were not associated. We have found that indoor exposure to nitrogen dioxide is associated with neither the incidence nor the duration of respiratory illnesses. The study was designed to have sufficient power to detect effects of nitrogen dioxide exposure of magnitudes previously reported and in a range relevant to public health concern; the lack of association cannot be attributed to potential bias from misclassification of outcome or exposure.(ABSTRACT TRUNCATED AT 400 WORDS)

Air Pollutants↗

PubMed1993

Nitrogen dioxide and respiratory illness in children. Part II: Assessment of exposure to nitrogen dioxide.

Repeated measurements of nitrogen dioxide were obtained from 1988 to 1991 in the homes of 1,205 infants living in Albuquerque, NM. Passive diffusion samplers were used to obtain a series of two-week integrated measurements from the home of each infant for use in a cohort study of the relation of residential exposure to nitrogen dioxide and respiratory illnesses. Information on stove use and time spent inside the residence was collected at two-week and two-month intervals, respectively. During the winter, in the bedrooms of homes with gas cooking stoves, mean nitrogen dioxide concentrations were 21 parts per billion (ppb); mean concentrations in the living room and kitchen were 29 ppb and 34 ppb, respectively. In homes with electric cooking stoves, the mean bedroom concentration was 7 ppb during the winter. Lower indoor concentrations were observed during the summer in homes with both gas and electric stoves. On average, infants spent approximately 12.3 hours per day in their bedrooms, 7.3 hours in the living rooms, 35 minutes in the kitchens, and 3.8 hours out of their homes. (As a condition of participation, none of the infants spent more than 20 hours per week in day care outside of their homes). The mean time infants spent in the kitchen during cooking was approximately nine minutes per day. We tested whether exposures of infants living in homes with gas stoves could be reasonably estimated by measurements in the bedroom in comparison with time-weighted average concentrations based on time-activity data and simultaneous nitrogen dioxide measurements in the kitchen, living room, and bedroom. In 1,937 two-week intervals from 587 infants, 90% of time-weighted exposure (on the three-level classification used in this study) estimates were in agreement with estimates based on bedroom concentrations alone. The agreement of the time-weighted nitrogen dioxide exposure estimates with the bedroom concentrations is attributed to limited amounts of cooking stove use (the mean was 29 minutes per day), small room-to-room differences in nitrogen dioxide concentrations (the mean kitchen-bedroom difference was 12 ppb), and the relatively large proportion of time that infants spent in their bedrooms.

Air Pollution, Indoor↗

PubMed1992

Geographic variation in the treatment of localized breast cancer.

BACKGROUND: Breast-conserving surgery followed by radiation therapy is as effective as modified radical mastectomy in treating women with localized breast cancer, as demonstrated by clinical trials reported during the 1980s. The extent to which breast-conserving surgery has been adopted in various regions of the United States is not known. METHODS: We assessed variations in the use of breast-conserving surgery from 1983 to 1986 in 18,399 non-Hispanic white, 324 Hispanic, and 1174 black women with breast cancer in nine areas of the United States, using data from the Surveillance, Epidemiology, and End-Results Program of the National Cancer Institute. RESULTS: The proportion of white women with localized breast cancer who underwent breast-conserving surgery ranged from 9.2 percent (Iowa) to 32.1 percent (Seattle) in 1983-1984 and from 19.6 percent (Iowa) to 41.5 percent (Seattle) in 1985-1986. Between 1983 and 1986, the use of breast-conserving surgery increased in each area, but the relative rankings of the areas changed little. The frequency of the use of breast-conserving surgery in black and Hispanic women was comparable to that in white women. The proportion of women who received radiation therapy after breast-conserving surgery also varied geographically and increased from 1983 to 1986 in all areas. Older women in all areas and black women in Atlanta and Detroit were less likely than other women to receive radiotherapy after breast-conserving surgery. CONCLUSIONS: There is marked variation in the United States in the use of breast-conserving surgery for localized breast cancer. The variation is not explained by demographic factors, although race and age affect the use of radiotherapy after breast-conserving surgery.

Black or African American↗

PubMed1992

Longitudinal study of dietary intakes and plasma lipids in healthy elderly men and women.

Dietary intakes and blood lipid concentrations were assessed in elderly men (n = 65) and women (n = 92) from 1980 through 1989. Mean age in 1980 was 70 y (range 60-84 y). Health and socioeconomic status was above that found in the general US elderly population. Cross-sectional and longitudinal changes in variables were determined by using least-squares linear regression. No significant cross-sectional differences in energy (kJ/kg), protein (g/kg), total fat, and carbohydrate intake with age was noted. Significant longitudinal decreases in total fat, saturated and polyunsaturated fatty acids, and cholesterol intakes were noted in both men and women. Significant decreases in total, HDL, and LDL plasma cholesterol concentrations were noted over time in both men and women. Ratios of both total and LDL cholesterol to HDL cholesterol increased over time. The decrease in total fat and cholesterol intakes were significantly correlated with the decrease in total plasma cholesterol.

Aged↗