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Cigarette smoking and breast cancer.

A priori hypotheses suggest that cigarette smoking could either increase or decrease breast cancer incidence. To clarify these competing hypotheses, we used data from a very large population-based breast cancer case-control study to investigate the impact of smoking on breast cancer risk. Breast cancer patients less than 75 years old were identified from statewide tumor registries in Wisconsin, Massachusetts, Maine, and New Hampshire; controls were randomly selected from driver's license lists (age less than 65) or lists of Medicare beneficiaries (age 65-74). Information on reproductive history, medical history, and personal habits including cigarette smoking was obtained by telephone interview. A total of 6,888 cases and 9,529 controls were interviewed. There was virtually no relationship between current smoking and breast cancer risk (multivariate odds ratio, 1.00; 95% confidence interval, 0.92-1.09), and former smokers had a barely increased risk (odds ratio, 1.10; 95% confidence interval, 1.01-1.19). Similar results were observed among both premenopausal and postmenopausal women. There was no suggestion that heavy or long-term smoking increased or decreased risk, nor were there indications that women who began smoking at an early age were at increased risk, as has been hypothesized. The results of this large population-based study indicate that smoking does not influence the risk of breast cancer, even among heavy smokers who began smoking at an early age.

Age Factors↗

Design or accident? The natural history of teenage pregnancy.

The UK has the highest rate of teenage pregnancy in Western Europe. A retrospective record-based study was conducted in an East Devon general practice to gain greater understanding of the outcome of first teenage pregnancy and subsequent reproductive history. The comparison group was women who had first conceived between the ages of 25 and 29 years. 149/673 women born between 1968 and 1977 became pregnant when teenagers. Of these, 70 (47%) had the baby, 67 (45%) had a termination and 10 (7%) had a spontaneous miscarriage; 2 others experienced fetal loss. Of the women aged 25-29 at first conception, 127 (92%) had the baby, 6 (4%) had a termination and 5 (4%) had a miscarriage. 40 (27%) of the teenage group went on to have a second teenage pregnancy, including 12 of the 67 who had their first pregnancy terminated. Although teenage pregnancy is often viewed as unplanned and unwanted, the reality is more complex. Among this group, many first pregnancies were desired. Even among those whose first pregnancy was terminated, 18% went on to have a baby while still a teenager.

Abortion, Induced↗

Breast cancer risk: protective effect of an early first full-term pregnancy versus increased risk of induced abortion.

PURPOSE/OBJECTIVES: To examine the question of whether an early first full-term pregnancy (FFTP) protects against breast cancer and whether interruption of the pregnancy with an induced abortion increases breast cancer risk. DATA SOURCES: Published medical and epidemiology journal articles, books, scientific reports, news interviews of researchers, scientific journals. DATA SYNTHESIS: Continually increasing breast cancer rates cannot be explained by the American Cancer Society risk factors, which account for only 25% of cases. Induced abortion is a newly recognized risk factor and has been prevalent in our society since it was legalized in 1973. CONCLUSIONS: Early FFTP confers protection, while induced abortion confers risk. Most specific and controlled variables studies indicate 150% risk for abortions performed on women younger than 18 years of age. Studies have yet to discover the full impact of induced abortion because women who underwent legalized abortion in 1973 are just reaching ages of highest breast cancer incidence. IMPLICATIONS FOR NURSES: Awareness of a controversial risk factor and its relevance to women allows nurses to include this information when educating and supporting patients. Specifically, nurses need to include questions on this reproductive risk when eliciting a patient's reproductive history. Nurses should further be aware of the emotional impact disclosure may have.

Abortion, Induced↗

Menstrual and reproductive factors and the mortality risk of gastric cancer in Japanese menopausal females.

OBJECTIVE: The relationship between gastric cancer and menstrual and reproductive history was investigated for 40,535 postmenopausal females from a large-scale prospective cohort in Japan (JACC: Japan Collaborative Cohort Study for Evaluation of Cancer Risk, sponsored by Monbusho). METHODS: A Cox proportional hazard model was used to estimate risk with respect to menstrual and reproductive factors for gastric cancer mortality. The effects on risk of potential confounders such as lifestyle, dietary habits, and socioeconomic status were controlled for using a stepwise procedure. RESULTS: During the study period (mean 8.2 years), 156 deaths due to gastric cancer were identified. Longer fertility tended to be inversely associated with risk of gastric cancer mortality, although the association was not significant. Late menopause had no obvious effect on gastric cancer risk. The risk ratio of delivery experience compared to no delivery was 0.62 (95% confidence interval 0.27-1.41), and this effect was consistent regardless of the number of deliveries. Early menarche was not associated with the risk of gastric cancer. The potential confounders were not seen to have distinct effects on the associations. CONCLUSIONS: Multiparity appears to confer a protective tendency on gastric cancer mortality; however, this result is inconsistent with previous reports. Further information needs to be accumulated from epidemiological studies in order to clarify the role of reproductive factors in gastric cancer.

Adult↗

Reproductive factors and risk of uterine fibroids.

We analyzed the relation between reproductive history and risk of uterine fibroids using data from a case-control study. Cases were 621 women with histologically confirmed diagnosis of uterine fibroids. Controls were 1,051 non-hysterectomized patients. Compared with nulliparae, parous women had a relative risk (RR) of fibroids of 0.5 [95% confidence interval (CI) = 0.4-0.6], and the risk declined with number of births. The risk of fibroids also decreased with number of induced abortions (RR = 0.8 and 0.6 for women reporting one or two or more abortions, respectively). A total of 24 cases (3.9%) and 19 controls (1.8%) reported a history of infertility (RR = 2.0; 95% CI = 1.1-3.7).

Adult↗

Reproductive consequences of an X-autosome translocation in a swine herd.

A survey was conducted on the chromosome makeup and breeding data of pigs housed at the Arkell Research Station, University of Guelph, to determine the reproductive impact of a reciprocal translocation previously identified as t(Xp+;14q-). Blood samples were cultured and chromosome spreads were examined to identify carriers in the herd. Gonadal features of carrier boars and piglets and their age-matched normal counterparts were studied, and the reproductive history of carrier sows, including the number of breedings required for conception, mean litter size, prevalence of still births and malformations, and sex distribution among the piglets, was compared with that of normal (noncarrier) sows. Our observations on testicular histology confirmed that X-autosome translocation-carrier boars are sterile, and the analysis of reproductive data showed that the most striking effects of t(Xp+;14q-) on sows are the 50% increase in the number of breedings required for conception and the over 25% reduction in litter size compared with that of normal sows. The reproductive impact of this and similar translocations on the herd and on the swine industry in general is discussed.

Animals↗

Review article: epidemiology of male breast cancer. A meta-analysis of published case-control studies and discussion of selected aetiological factors.

Male breast cancer is a rare tumour in all parts of the world. About 1% of all breast cancers occur in men, but the male/female ratio is higher among black than among white populations. This effect can be seen in US cancer registries and even more markedly in African data. A positive correlation exists on a population scale between male breast cancer and prostate cancer. Seven case-control studies of male breast cancer are available, and a pooled analysis was conducted of the most commonly suspected risk factors. Male breast cancer appears to be associated with marital status: Mantel-Haenszel exposure odds ratio (EOR) for never married = 1.6; 95% confidence limits (CL) = 1.1, 2.3, religion (EOR for being Jewish = 2.1; 95% CL = 1.4, 3.2), previous breast pathology (EOR for positive history of benign breast disease = 2.7; 95% CL = 1.7, 4.2), gynaecomastia (EOR for positive history = 6.2, 95% CL = 3.4, 11.4), previous testicular pathology (EOR for positive history = 2.2; 95% CL = 1.5, 3.3), previous liver diseases (EOR for positive history = 1.6; 95% CL = 1.0, 2.4) and family history of breast cancer (EOR for first-degree relative with breast cancer = 2.5; 95% CL = 1.7, 3.7). No association is found with smoking history. Other potential risk factors such as reproductive history, education, occupation, anthropometric variables, association with various diseases, and specific exposures such as drug use, were not systematically evaluated in all studies and provide sometimes contradictory results, possibly due to small numbers of exposed subjects. Overall, the analytical epidemiology of male breast cancer presents similarities with the epidemiology of female breast cancer, with a potential role of factors related to hormonal status, relative hyperoestrogeny in men being potentially linked to increased risk of disease. Genetics may also play a role, with high risk linked to a familial history of breast cancer, and with a major risk in patients with Klinefelter's syndrome.

Age Factors↗

Reduced risk of esophageal cancer associated with green tea consumption.

BACKGROUND: Studies in laboratory animals have suggested inhibitory effects of green tea on the induction of some cancers, notably, esophageal cancer. However, only a few epidemiologic studies have evaluated green tea as a potential inhibitor of human esophageal cancer. PURPOSE: Our purpose was to evaluate the relationship between green tea consumption and the risk of esophageal cancer. METHODS: This esophageal cancer study was part of a larger multicenter, case-control study that included three other gastrointestinal sites (pancreas, colon, and rectum). Medical records of patients aged 30-74 years old who were diagnosed with esophageal cancer from October 1, 1990, through January 31, 1993, were identified from the Shanghai Cancer Registry, which covers 6.8 million people in the urban area of Shanghai, People's Republic of China. During the ascertainment period, records of 1016 eligible cases of esophageal cancer were identified. Control subject records were selected by frequency matching in accordance with the age-sex distribution of the four gastrointestinal cancers ascertained by the cancer registry during 1986-1987. Patient interviews were then conducted using a structured, standardized questionnaire to obtain information on demographic characteristics, residential history, height and weight, diet, smoking, alcohol and tea drinking, medical history, family history of cancer, occupation, physical activity, and reproductive history. RESULTS: Of the 902 patients interviewed, 734 (81.4%) had their disease pathologically confirmed. There were 1552 control subjects interviewed, including 240 alternates. All analyses of tea effects were conducted separately among men and women and all were adjusted for age. After further adjustment for other known confounders, a protective effect of green tea drinking on esophageal cancer was observed among women (odds ratio [OR] = 0.50; 95% confidence interval [CI] = 0.30-0.83), and this risk decreased (P for trend < or = .01) as tea consumption increased. Among men, the ORs were also below 1.00, although not statistically significant. ORs for green tea intake were estimated among those persons who neither smoked nor drank alcohol. In this subset, statistically significant decreases in risk among tea drinkers were observed for both men (OR = 0.43; 95% CI = 0.22-0.86; P for trend = .05) and women (OR = 0.40; 95% CI = 0.20-0.77; P for trend < .001). CONCLUSIONS: This population-based, case-control study of esophageal cancer in urban Shanghai suggests a protective effect of green tea consumption. Although these findings are consistent with studies in laboratory animals, indicating that green tea can inhibit esophageal carcinogenesis, further investigations are definitely needed.

Adult↗

Surveying disabilities in Mafraq District in Jordan in view of approaching community based rehabilitation.

Disabilities in Mafraq District in Jordan were identified using active case detection. The identified disabilities were characterized by type, sex and age of the disabled as well as other variables pertaining to the reproductive history of their mothers and certain socioeconomic variables pertaining to their families. The results indicated an unmet need regarding services addressing the disabled and that they belong to poor families with high prevalence of illiteracy. The results also showed that the prevalence of consanguineous marriages as well as pregnancy at the two extremes of women's reproductive life is associated with congenital disability. The results were availed to the responsible authorities to facilitate embarking on Community Based Rehabilitation (CBR) in the district.

Adolescent↗

Sexually transmitted diseases and other risk factors for cervical dysplasia among southwestern Hispanic and non-Hispanic white women.

OBJECTIVE: To assess risk factors for high-grade cervical dysplasia among southwestern Hispanic and non-Hispanic white women. DESIGN: Clinic-based case-control study. SETTING: University-affiliated gynecology clinics. SUBJECTS: Cases were Hispanic and non-Hispanic white women with biopsy-proven high-grade cervical dysplasia (n = 201). Controls were Hispanic and non-Hispanic white women from the same clinics with normal cervical epithelium (n = 337). METHODS: Study design included interviews focused on histories of sexually transmitted diseases, sexual behavior, reproductive histories, hygienic practices, contraceptive use, cigarette smoking, and diet. Laboratory studies included bacterial and protozoal cultures of the cervix; hybridization tests to identify human papillomavirus (HPV) genome with commercial (ViraPap and ViraType) and polymerase chain reaction-based assays; and serum antibody tests for herpes simplex virus, Chlamydia trachomatis, syphilis, hepatitis B, and hepatitis C. RESULTS: For both ethnic groups combined, after adjustment for ethnicity, age, and sexual behavior, the strongest risks for cervical dysplasia were associated with cervical HPV infection as identified by ViraPap (odds ratio [OR], 12.8; 95% confidence interval [CI], 8.2 to 20.0) or with polymerase chain reaction (OR, 20.8; 95% CI, 10.8 to 40.2). Other factors associated with dysplasia included cigarette smoking at the time of diagnosis (OR, 1.8; 95% CI, 1.2 to 2.8); low income (OR, 2.2; 95% CI, 1.2 to 4.0); low educational level (OR, 6.2; 95% CI, 3.4 to 11.1); history of any sexually transmitted disease (OR, 1.9; 95% CI, 1.3 to 2.7); and seroprevalence of antibodies to hepatitis B (OR, 1.8; 95% CI, 0.9 to 3.5). For Hispanic women, HPV 16/18 identified by ViraType was strongly associated with cervical dysplasia (OR, 171.0; 95% CI, 22.8 to 1280.5). Antibodies to herpes simplex virus type 2 were not associated with dysplasia in Hispanic women but were significantly associated with dysplasia among non-Hispanic whites. Risks associated with cigarette smoking also varied by ethnic group. CONCLUSIONS: The strongest risk factor associated with high-grade cervical dysplasia among clinic attendees was HPV infection. Although most of the risk factors we examined showed similar associations for dysplasia for both ethnic groups, our data suggest that several different risk factors may be relevant to the development of cervical dysplasia in Hispanics compared with non-Hispanic whites who attend the same clinics.

Adolescent↗

Isolated esophageal atresia and perinatal risk factors.

Esophageal atresia (EA) is a relatively rare alimentary tract congenital anomaly. We studied perinatal risk factors of 90 live birth cases of isolated EA with (40 cases) or without (50 cases) tracheal fistula. We found sex ratios of 1.43 for total EA cases and 1.5 for both subgroups of EA with or without tracheal fistula. Evaluation of parity showed statistically significant values for low parity and for high multiparity for EA with and without tracheal fistula. Birth weight evaluation revealed statistically significant values for both subgroups. We did not find statistical significance both for maternal age and gestational age. The etiology of esophageal atresia is complex and heterogeneous and within each subgroup, apparently different etiologies may exist, resulting in differences in epidemiologic characteristics. Moreover, some causes linked to genetics and gene-environment interaction may be involved. We think that parity and low birth weight can be considered as risk factors for EA, and an accurate evaluation of reproductive history can be useful for the provision of genetic and perinatal counseling.

Case-Control Studies↗

Reproductive factors and incidence of breast cancer: an international ecological study.

Ecological studies can help in understanding the relation of reproductive history of breast cancer. We analyzed data from 9416 women, comprising the control groups of seven countries (Australia, People's Republic of China, Colombia, (former) German Democratic Republic, Israel, Philippines, and Thailand) from the WHO international, multi-center case-control study of female cancers. Positive correlations with country-specific breast cancer incidence were observed for (median) duration of reproductive life (r > or = 0.95, p < 0.005), age at menopause (r > or = 0.84, p < 0.025) and delay to first birth (r > or = 0.59, p < 0.22) (when People's Republic of China was omitted, r > or = 0.85, p < 0.07). The association of age at first birth with breast cancer incidence was weakly positive in the whole sample (age-adjusted r = 0.18, p = 0.73), but weakly negative in the age groups 15-29 and 30-39 years and weakly positive in the age groups 40-49 and 50-64 years. A strong inverse correlation was observed between age at menarche and breast cancer incidence (r < or = -0.84, p < 0.03). These international ecological correlations agree with the associations previously reported for single populations, between higher incidence of breast cancer and younger age at menarche, older age at menopause, longer duration of reproductive life, and (possibly) longer delay to first birth. In contrast, age at first birth is only weakly related to breast cancer incidence across populations, indicating that this variable represents different constructs when measured ecologically versus individually.

Adolescent↗

Prevalence of factors influencing cancer risk in women with lupus: social habits, reproductive issues, and obesity.

OBJECTIVE: There is mounting evidence that hematological malignancies are increased in systemic lupus erythematosus (SLE), and the risk of certain solid tumors may also be increased. The pathogenesis may be different for the 2 processes: risk of hematological malignancies in SLE may be due to chronic lymphocyte stimulation, while risk of solid tumors may be influenced by factors such as obesity and reproductive habits. We aimed to determine prevalence in a lupus cohort of selected factors that influence the risk of cancer, and to compare this prevalence to that of the general population. METHODS: Subjects were women followed in the Montreal General Hospital Lupus Clinic. We administered a postal survey of factors known to be associated with lung and aerodigestive cancers (smoking, alcohol use) as well as factors associated with breast and gynecologic cancers (nulliparity, use of oral contraceptives, and hormone replacement therapy). For patients who had died or been lost to followup, data were abstracted from clinic records. Information about nonsteroidal antiinflammatory drug (NSAID) use (a potentially protective factor for colorectal cancer) was also collected. Obesity prevalence was established from the clinic database. Comparison figures were obtained from the 1996-1997 National Population Health Survey data for Quebec women and age adjusted, where possible. RESULTS: Compared to the general population, the lupus population had lower prevalence of current use of oral contraceptives, and greater prevalence of obesity and nulliparity. The average number of pack-years among smokers was also greater in the lupus cohort. CONCLUSION: Solid cancer incidence in SLE may be influenced by established cancer risk factors such as smoking, obesity, and reproductive history.

Adult↗

Hormonal factors and pancreatic cancer in women.

PURPOSE: The aim of the study was to evaluate hormonal risk factors for carcinoma of the exocrine pancreas among postmenopausal women. METHODS: Mailed questionnaire data from 52 cases and 233 population-based controls in Ontario were used to assess parity, age at first birth, and other hormonal factors on pancreatic cancer risk. RESULTS: Reduced risk was seen with three or more pregnancies [adjusted odds ratio (OR) = 0.22, 95% confidence interval (CI) = 0.07-0.65] and use of oral contraceptives (adjusted OR = 0.36, 95% CI = 0.13-0.96), whereas no significant associations were found for age at menarche or menopause, or estrogen replacement therapy. Among parous women, later age at first full-term pregnancy significantly increased the risk of this cancer (adjusted OR = 4.05, 95% CI = 1.50-10.92 for ages 25-29 years, adjusted OR = 3.78, 95% CI = 1.02-14.06 for ages 30+ years). CONCLUSIONS: Our data support the hypothesis that pancreatic cancer is, at least in part, an estrogen-dependent disease; there is growing epidemiological evidence that aspects of reproductive history and hormonal exposure are associated with risk of this disease.

Adolescent↗

Reproductive risk factors for incident bladder cancer: Iowa Women's Health Study.

We studied the association between reproductive factors and bladder cancer incidence in a prospective cohort study of 37,459 Iowa women aged 55-69 years and initially free from cancer in 1986. Women reported reproductive history and were followed prospectively through 2003. After adjusting for age and smoking, there was an inverse association between age at menopause and incident bladder cancer (n = 192). Compared with menopause at age > or =48, the hazard ratio (HR) of bladder cancer was 1.32 (95% CI; 0.90-1.94) for menopause at 43-47, and 1.60 (95% CI; 1.06-2.39) for < or =42 (p-trend = 0.02). The associations were similar for ages at natural and surgical menopause. In addition, women with a history of bilateral oophorectomy had an increased risk of bladder cancer compared with those who did not undergo bilateral oophorectomy: HR = 1.58 (95% CI; 1.12, 2.22). Finally, there was an indication of a positive association between bladder cancer and shorter lifetime years of ovulation (p-trend = 0.09). There were no associations between incident bladder cancer and age at first birth, number of births, age at menarche, use of hormone replacement therapy or any other reproductive characteristics. This study provides evidence that increased risk of bladder cancer is associated with earlier age at menopause in postmenopausal women.

Age Factors↗

Oral contraceptive use after conception in relation to the risk of congenital urinary tract anomalies.

The authors conducted a case-control study of the relation of OC use after conception to the occurrence of congenital urinary tract anomalies (CUTAs). Singleton CUTA cases with no known chromosomal abnormality from seven counties in western Washington State born during the period January 1, 1990-December 31, 1991 were identified through the Washington State Birth Defect Registry. Controls without birth defects were randomly selected from singleton births that occurred in the same year as the cases in five large hospitals in King County. Mothers of the 118 cases and 369 controls were interviewed to obtain their contraceptive history as well as other information. Mothers of nine cases (7.6%) and eight controls (2.2%) had taken OCs at some time during the pregnancy. After adjustment for birth year and county of maternal residence, OC use after conception was associated with an almost five-fold increased risk of having a baby with a CUTA [odds ratio (OR) = 4.8, 95 percent confidence interval (CI), 1.6-14.1] relative to no contraception at or after conception. Use of other contraceptive methods after conception was not related to the risk of CUTAs. OC use during the 3 or 6 months prior to the conception also was not associated with the risk of CUTAs. Further adjustment for sociodemographic factors, reproductive history, perinatal exposure to exogenous agents, and past OC use did not change the results, nor did restricting the analysis to residents of King County.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Drug-Induced↗

Reproductive and hormonal risk factors for thyroid cancer in Los Angeles County females.

We conducted an individually matched case-control study (292 pairs) of female thyroid cancer patients to examine the role of reproductive history and exogenous hormones in this disease. Radiation treatment to the head or neck [28 cases and 2 controls exposed; odds ratio (OR), 14.0; 95% confidence interval (CI), 3.5-121.3] and certain benign thyroid diseases (including adolescent thyroid enlargement, goiter, and nodules or tumors) were strongly associated with thyroid cancer. Irregular menstruation increased risk (OR, 1.8; 95% CI, 0.9-3.7). Age at menarche and pregnancy history were not related to disease. Women with natural menopause and hysterectomized women without oophorectomy had no increase in risk, but disease risk was elevated in women with bilateral oophorectomy (OR, 6.5; 95% CI, 1.1-38.1). In general, use of oral contraceptives and other exogenous estrogens was not associated with thyroid cancer. However, risk increased with number of pregnancies in women using lactation suppressants (P = 0.03) and decreased with duration of breastfeeding (P = 0.04). These data provide only limited support for the hypothesis that reproductive and hormonal exposures are responsible for the marked excess of thyroid cancer risk in adult females.

Adenocarcinoma, Follicular↗

Dietary habits, reproductive and menstrual factors and risk of dysmenorrhoea.

In order to analyze risk factors for dysmenorrhoea, we conducted a case-control study. Cases were 106 women (median age 27 years) with moderate or severe dysmenorrhoea lasting 12 months or more. Controls were 145 women (median age 26 years) without dysmenorrhoea, admitted for routine gynecological examination at the outpatient gynecological services of the same clinic where cases had been identified. In comparison with women reporting short menstrual cycles (every 25 days or less) the relative risk (RR) of dysmenorrhoea was 2.0 and 2.6, respectively, in those reporting their menstrual cycles of 26-30 days and of 31 days or more, and the RR was 3.6 (95% confidence interval (CI): 1.0-13.4) for women reporting totally irregular menstrual cycles. The estimated RRs were, in comparison with women reporting menstrual flows lasting 4 days or less, respectively 2.2 and 1.9 in those reporting menstrual flows lasting 5 and 6 days or more. Fourty-four (58%) cases but only seven (5%) controls reported heavy menstrual flows (RR in comparison with women reporting slight or normal menstrual flow 12.6, 95% CI: 5.0-32.1). As regards dietary factors, no associations emerged between the various food items, with the exception of cheese and eggs, which tended to be more frequently consumed by cases than controls. The results of this study suggest that the risk of dysmenorrhoea is higher in women with irregular, long and heavy menstrual flows. No association emerged between reproductive history and dysmenorrhoea. Likewise, no clear relationship emerged between intake of several dietary factors and risk dysmenorrhoea.

Adult↗