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PubMed1999

Cancer mortality among women employed in health care occupations in 24 U.S. states, 1984-1993.

BACKGROUND: Health care workers are potentially exposed to a number of carcinogens. Studies among women in this field have focused on white nurses; however, workers in many health care occupations share exposures experienced by nurses. METHODS: Cancer mortality was examined among female health care workers using death certificate data collected in 24 U.S. states from 1984 through 1993. Cancer mortality odds ratios (MORs) were calculated by race (white, black) and age group. RESULTS: White nurses had a 30% elevation of mortality due to liver cancer and myeloid leukemia. White registered nurses (RNs) had a small excess and white licensed practical nurses (LPNs) had a small deficit of mortality due to breast cancer. Ovarian cancer was in excess among RNs, but decreased among LPNs. Among black nurses, excesses of death due to kidney cancer (MOR = 1.7) and multiple myeloma (MOR = 1.3), and a significant 50% deficit in mortality due to cancer of the esophagus were found. Black RNs, but not LPNs, had an excess of breast cancer (MOR = 1.3; 95% CI = 1.0-1.5). Ovarian cancer was elevated by 30% in both RNs and LPNs. Excess deaths due to cancers of the breast, ovary, and uterus occurred among white physicians. Among black physicians, lung cancer was significantly elevated (MOR = 2.8). White pharmacists had significant excesses of breast (MOR = 1.5) and ovarian (MOR = 2.4) cancers, and myeloid leukemia (MOR = 2.0). White clinical laboratory technicians had excess deaths from several cancers. The greatest excess was for myeloid leukemia (MOR = 2.3; 95% CI = 1.5-3.4). Excesses among radiologic technologists included cancers of the lung, pancreas, breast, uterus, and ovary. CONCLUSION: Several findings reported here warrant further investigation. In particular, excesses of myeloid leukemia among nurses, pharmacists, and clinical laboratory technicians and liver cancer among nurses should be investigated in studies with data on occupational and other exposures. Patterns of mortality from breast and ovarian cancer found in this study must be evaluated further in studies with data on reproductive history.

Adult↗
PubMed1999

Ovarian cancer and occupational exposures in Finland.

BACKGROUND: No single occupational or environmental agent has been established as causing ovarian cancer, existing studies often being based on ecologic or proportional mortality data in which potential confounders related to reproductive history have not been taken into account. METHODS: This study linked 324 job titles of occupationally active Finnish women (n = 892,591) at 1970 census with incidence of ovarian cancer (Finnish Cancer Registry, 5,072 cases) during 1971-1995 (over 15 million person-years). The job titles were converted into indicators of exposure to 33 agents, using a national job-exposure matrix based on measurements and surveys (FINJEM). Poisson regression analyses were performed with stratification by birth cohort, follow-up period, and socioeconomic status, and adjusted for mean number of children, mean age at first delivery, and turnover rate for each job title. RESULTS: We found indications of elevated risks for aromatic hydrocarbon solvents (standardized incidence ratio 1.3 (95% CI 1.0-1.7), leather dust (1.4; 0.7-2.7), man-made vitreous fibers (1.3; 0.9-1.8), and high levels of asbestos (1.3; 0.9-1.8), and diesel (1.7; 0.7-4.1), and gasoline (1.5; 1.0-2.0) engine exhausts). Previously reported findings for hairdressers and women in the printing industry were supported in our data, but not for women in dry cleaning jobs. CONCLUSIONS: Given the various drawbacks in linkage studies and job-exposure matrices, the excesses found in this study need confirmation in individual-level studies.

Adult↗
PubMed1980

Parity and prognosis in breast cancer.

Analysis of five-year disease-free survival rates in 608 women with operable breast cancer revealed that the reproductive history is a significant prognostic determinant. Overall parous women had a significantly higher cumulative five-year disease-free survival rate (60%), compared to the nulliparous (46%) (z = 2.5, p = 0.012). Significant differences were also noted when gravidity in addition to parity was taken as the determinant. The corresponding disease-free survival rates were 61% and 50%, respectively (z = 1.98, p = 0.048). Five-year survival rates were influenced in a similar manner by these variables but the observed differences were less significant. The trend toward higher survival rates in parous and gravidae women were noted in all tumor stages but achieved statistical significance only in stage III. The findings indicate that parity and gravidity affect not only the risk of breast cancer development but also the subsequent course of the disease. Parity seems to be a strong risk and prognostic factor than gravidity.

Breast Neoplasms↗
PubMed1980

Familial influences on breast parenchymal patterns.

Some studies accomplished thus far have indicated that mammographic patterns may serve as risk indices for breast cancer. The present investigation was undertaken to determine whether patterns are familial. Mammograms from 110 mothers and their daughters and 122 sister pairs and a like number of unrelated controls matched for patient age, reproductive history, and personal and family history of breast cancer and drawn from the files of the Radiology Department of Hutzel Hospital, Detroit, Michigan, were compared. A familial influence was indicated by the finding that pattern similarities were significantly stronger in test cases than in unrelated controls. This influence appeared to be manifested by premature age changes in daughters and younger sisters and consisted, primarily, of a decrease in DY and an increase in P2 patterns. The data suggest that performing mammography on first degree relatives of women with high risk P2 and DY patterns should be considered.

Adult↗
PubMed1980

Epidemiologic features of rapidly progressing breast cancer in Tunisia.

A form of breast cancer characterized by rapid disease progression, inflammation, and edema is found in approximately 55% of the breast cancer patients presenting at the Institute Salah Azaiz, Tunis (Tunisia). In 581 patients seen between January 1, 1969, and December 31, 1974, we examined age, place of residence, reproductive history, delay in seeking treatment, and blood gropu as potential risk factors to determine the distinction between the rapidly progressing disease and the less aggressive form. Rural residence, blood type A, and recent pregnancy are risk factors among premenopausal women, but older age, rural residence, blood type A, late menarche, and delay in diagnosis are associated with postmenopausal rapidly progressing breast cancer. The most significant risk factors were rural residence and blood type A. Rapidly progressing breast cancer was diagnosed in two of every three breast cancer patients coming from a rural environment. Forty-three percent of 203 patients with rapid disease progression were blood type A, a significantly higher percentage than the 33% found in the general Tunisian population and the breast cancer patients without evidence of rapidly progressive disease. We observed that the risk factors for disease progression were quite different from those reported to influence the incidence of breast cancer.

Adult↗
PubMed1989

A case-control study of risk factors for sarcomas of the uterus. The World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives.

Using data collected as part of the hospital-based World Health Organization (WHO) Collaborative Study of Neoplasia and Steroid Contraceptives, the authors examined potential risk factors for sarcoma of the uterus. Twenty-nine patients with uterine sarcoma who were between 15 and 56 years of age and diagnosed at one of nine centers were matched on age and center to 198 controls selected from hospital admissions to other than obstetric and gynecologic wards. All women were interviewed regarding their medical and reproductive history, methods of birth control, and history of sexual relationships and of sexually transmitted infections. The risk of uterine sarcoma was lower in parous women compared to nulliparous women (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.1, 3.3), and the risk decreased with increasing number of live births. A greater proportion of cases than controls reported giving birth to their first child at the age of 25 or later, even after adjustment for parity (OR = 3.5; 95% CI = 1.2, 10.9). Cases were also more likely than controls to report a history of a spontaneous abortion (OR = 2.5; 95% CI = 0.8, 7.4) or an induced abortion (OR = 1.6; 95% CI = 0.4, 6.3). Late menarche and early menopause were both positively associated with the risk of uterine sarcoma. No association was observed with a history of infertility, use of oral contraceptives, or measures of sexual activity. The findings with respect to childbearing and menstrual history differ from those of a recent cohort study, and indicate the need for larger investigations to assess the role of these and other risk factors in the occurrence of sarcomas of the uterus.

Abortion, Spontaneous↗
PubMed2001

The polymorphic CAG repeat in the androgen receptor gene in Jewish Israeli women with endometrial carcinoma.

BACKGROUND: Endometrial carcinoma is considered a hormonal-dependent tumor; estrogen induces endometrial cellular proliferation, whereas progestins display an antiproliferative effect on endometrial tissue. The role that androgen and its receptor (androgen receptor [AR]) play in the pathogenesis of endometrial carcinoma is less clear. Although androgen has an in vitro inhibitory effect on endometrial cell proliferation, up to 75% of endometrial carcinoma express AR somatically. A polymorphic CAG repeat within exon 1 of the AR encodes for a polyglutamine tract, with length range of 8 to 33 repeats, which is inversely correlated with the transcriptional activity of the AR. METHODS: To gain insight into the role of AR in endometrial carcinoma, the authors analyzed the polymorphic CAG repeat in 79 Jewish Israeli patients with endometrial carcinoma as compared with 44 healthy Jewish women serving as controls. Analysis was conducted using germline DNA as template and using polymerase chain reaction primers flanking the CAG repeat with subsequent fluorescent determination of allele sizes. RESULTS: Allele size range of the longer of the two alleles in the patients was 11-33 (mean, 19.8 +/- 2.7) and in the controls 10-22 (mean, 17.9 +/- 1.9), a statistically significant difference (P < 0.01). Allele size variation within the patient group did not correlate with disease stage, grade, reproductive history, or age at diagnosis. CONCLUSIONS: The authors conclude that AR-CAG repeat length differs in Jewish patients with endometrial carcinoma as compared with healthy individuals in Israel, and this finding increases the possibility that the AR is involved in the predisposition to this neoplasm.

Aged↗
PubMed2001

Genetic susceptibility to breast cancer in French-Canadians: role of carcinogen-metabolizing enzymes and gene-environment interactions.

Breast cancer is the most frequent malignancy among women. Since genetic factors such as BRCA1 and BRCA2 as well as reproductive history constitute only 30% of the cause, environmental exposure may play a significant role in the development of breast cancer. Likewise, the relevant enzymes involved in the biotransformation of xenobiotics (from tobacco smoke, diet or other environmental sources) might play a role in breast carcinogenesis. Since individuals with modified ability to metabolize these carcinogens could have a different risk for breast cancer, we investigated the role of cytochromes P-450 (CYP1A1, CYP2D6), glutathione-S-transferases (GSTM1, GSTT1, GSTP1) and N-acetyltransferases (NAT1, NAT2) gene variants in breast carcinogenesis. A case-control study was conducted on 149 women with breast carcinoma and 207 healthy controls, both of French-Canadian origin. The CYP1A1*4 allele was found to be a significant risk determinant of breast carcinoma (OR = 3.3, 95% CI 1.1-9.7), particularly among post-menopausal women (OR = 4.0, 95% CI 1.2-13.8). The frequency of NAT2 rapid acetylators was increased among smokers (OR = 2.6, 95% CI 0.8-8.2), while the NAT1*10 allele conferred a 4-fold increase in risk among women who consumed well-done meat (OR = 4.4, 95% CI 1.0-18.9). These data suggest that CYP1A1*4, NAT1 and NAT2 variants are involved in the susceptibility to breast carcinoma by modifying the impact of exogenous and/or endogenous exposures.

Arylamine N-Acetyltransferase↗
PubMed2006

The impact of menopause and lifestyle factors on blood and bone lead levels among female former smelter workers: the Bunker Hill Study.

OBJECTIVE: The Bunker Hill mine in Idaho operated from 1886 to 1981. In the 60's and 70's it provided approximately 25% of the primary lead in the United States. Women first began working on the production and maintenance lines in 1972. This study examines the impact of menopause and several occupational and lifestyle factors as determinants of blood and bone lead levels among 73 female former smelter workers. METHODS: Blood lead levels were analyzed using graphite furnace atomic absorption spectroscopy. The (109)Cd K X-ray fluorescence system was used to measure calcaneus and tibia bone lead content. Information was obtained on reproductive history, alcohol and cigarette consumption, education, and hormone replacement therapy (HRT). RESULTS: Postmenopausal women (n = 47) had significantly (P < 0.002) higher blood lead levels (3.48 microg/dl) than did premenopausal women (n = 26) (2.19 microg/dl). The best predictors of blood lead levels were smoking (>10 or < or =10 cigarettes/day), natural menopause, technical or community college education, manager or technical worker, and past or present use of HRT. The best predictors of calcaneus bone lead levels (P < 0.2) were technical workers, such as miner; natural menopause; and smoking >10 cigarettes/day; level of education; 1-2 pregnancies; and age (>60 years). CONCLUSIONS: Lead exposure results in higher blood lead levels especially during menopause.

Adult↗
PubMed1988

Effects of exposure to ethylene glycol ethers on shipyard painters: II. Male reproduction.

To determine whether 2-ethoxyethanol (2-EE) and 2-methoxyethanol (2-ME) affected the reproductive potential of exposed men, we examined the semen of 73 painters and 40 controls who work in a large shipyard. An industrial hygiene survey was performed to characterize the work environment. The men supplied information on demographic characteristics, medical conditions, personal habits, and reproductive history; underwent a physical examination; and provided a semen sample. Semen samples were analyzed for pH, volume, turbidity, liquidity, viability by stain exclusion and hypo-osmotic stress, sperm density and count per ejaculate, motility using a videotape technique, morphology, and morphometry. Serum was analyzed for testosterone, FSH, and LH. The industrial hygiene survey revealed that the painters were exposed to 2-EE at a time-weighted average (TWA) of 0-80.5 mg/m3 with a mean of 9.9 mg/m3, and to 2-ME at a TWA of 0-17.7 mg/m3 with a mean of 2.6 mg/m3. Painters had an increased prevalence of oligospermia and azoospermia and an increased odds ratio for a lower sperm count per ejaculate, while smoking was controlled. This finding is consistent with prior animal studies and with one human study. Potential biases and confounding of the data are discussed.

Adult↗
PubMed1989

Occupational mercury exposure and male reproductive health.

This retrospective cohort study was designed to investigate the relationship of male occupational exposure to elemental mercury and several reproductive outcomes. All subjects worked at least 4 months between 1953 and 1966 at a plant that used elemental mercury; 247 white male employees who had the highest exposures were compared to 255 matched nonexposed employees. Individual exposure to mercury was estimated from urinary mercury measurement records. Information on reproductive history and potential confounding variables was obtained through personal interview with each of the employees and with a subset of their wives. No associations were demonstrated between mercury exposure and decreased fertility or increased rates of major malformations or serious childhood illnesses. After controlling for previous miscarriage history, mercury exposure was not a significant risk factor for miscarriage. Because of this study's potential problems with long-term recall, further studies of the effect of mercury on pregnancy outcome are warranted in other populations.

Abortion, Spontaneous↗
PubMed1993

A preliminary study of reproductive outcomes of female maquiladora workers in Tijuana, Mexico.

Maquiladoras are plants on the Mexican side of the United States-Mexico border which are used largely by U.S. manufacturers to assemble premanufactured parts. We examined reproductive outcomes of women employed in electronics (N = 120) and garment (N = 121) maquiladora work compared to women employed in the service sector (N = 119) in Tijuana, Mexico. Women recruited by community health workers were interviewed about their reproductive history, sociodemographic characteristics, health behaviors, and characteristics of their current job. Length of regular menstrual cycle in the past year as well as time of conception and rates of fetal loss in the most recent pregnancy were similar across occupational groups. However, infants of garment maquiladora workers were 653 g lighter (95% confidence interval [CI]: -1,041 g, -265 g) and infants of electronic maquiladora workers were 337 g lighter (95% CI: -682 g, 9 g) than infants of service workers after adjusting for potential confounders. The cause of these differences remains unclear.

Abortion, Spontaneous↗
PubMed1979

Multiple congenital anomalies/mental retardation (MCA/MR) syndrome due to partial 1q duplication and possible 18p deletion: a study of four individuals in two families.

We have evaluated four individuals from two unrelated families with a similar multiple congenital anomalies/mental retardation (MCA/MR) syndrome due to partial duplication of chromosome 1q and possible deletion 18p. In both families the mothers and several relatives were carriers of the balanced translocation rcp t(1;18) (q42;p11). The features which the four have in common are relative macrocephaly, prominent forehead, micrognathia, and highly arched palate; three of the four individuals have short stature, scoliosis, kyphosis, hirsutism, camptodactyly, sacral dimple, repaired inguinal hernias, and eye abnormalities. Reproductive histories of five balanced translocation carriers in these families indicate that they have a high risk of spontaneous abortions and infants with multiple malformations.

Abnormalities, Multiple↗
PubMed1983

Enhancement of a fra(16)(q22) with distamycin A: a family ascertained through an abnormal proposita.

A family in which a fragile site at 16q22 was segregating was ascertained through a newborn infant with multiple anomalies. The same fragile site was present in the phenotypically normal father and in a brother with cleft palate. The fra(16)(q22) was similar in appearance, and in response to culture conditions, to that reported by other investigators, including increased breakage in media supplemented with distamycin A. Sampling variation in the frequency of breakage over time may be considerable in some individuals. No pattern of anomalies was found to be associated with the fragile site. However, the reproductive history of the family we report (two livebirths with major congenital anomalies and one stillbirth) suggests caution in concluding fra(16)(q22) is not deleterious.

Abnormalities, Multiple↗
PubMed1985

Possible causal heterogeneity in spina bifida cystica.

A study was performed to determine whether causal heterogeneity can be demonstrated among the nonsyndromal spina bifida cysticas based on the vertebral level of the defect. Two groups were compared, probands with defects at or above T 11, likely representing defects of neuralization, and probands with defects at or below T 12, likely defects of canalization. Differences between the two groups were found with respect to reproductive history and occurrence of other malformations. A high degree of concordance for the type of defect among affected sib pairs was also observed. These findings indicate that there is probably heterogeneity within the spina bifida cysticas based on the level of the defect.

Abnormalities, Multiple↗
PubMed1986

Neural tube defects: heterogeneity and homogeneity.

Detailed investigations were made on 150 fetuses with neural tube defects (NTD). After eliminating those with recognised causes, the rest were found to consist of fetuses with both isolated NTD and NTD with other developmental abnormalities. On evaluation of reproductive history, type and frequencies of NTD in pregnancies before conception, and sex of the fetuses involved, no demonstrable difference between these two types of NTD was found. Secondly, in those with additional developmental abnormalities, a significant clustering of developmental defects rather than a uniform distribution throughout abnormalities were found predominantly in cases of total craniorachischisis and upper thoracic spina bifida, less often in anencephaly and thoraco-lumbar spina bifida, and never in lumbo-sacral spina bifida. Thus it appears that there is not a random concurrence of other developmental abnormalities with NTD but a definite pattern. We suggest that this implies a connection between the developmental abnormality and the NTD and that the additional abnormalities arise due to mechanical induction by the particular specific disturbance of the neural tube and its surrounding tissues. The most important difference between isolated NTD and those with other associated abnormalities is that the disruption in development at neurulation is more far reaching in the latter than in the former.

Abortion, Spontaneous↗
PubMed1987

Chromosome anomalies as predictors of recurrence risk for spontaneous abortion.

Reproductive histories and chromosomes of spontaneous abortions were studied by segregation analysis in 1890 sibships ascertained through a cytogenetically studied abortion. Normal karyotypes are associated with recurrent abortion. Among abnormal karyotypes, trisomy has an elevated recurrence risk even after adjustment through a liability indicator for maternal age. Possible mechanisms and conflicting evidence in the literature on trisomy are discussed. None of these differences in recurrence risk is large enough to play a significant numerical role in genetic counseling.

Abortion, Spontaneous↗
PubMed2003

Familial cryptic translocation (2;17) ascertained through recurrent spontaneous abortions.

We report a young woman who presented with a reproductive history of three recurrent spontaneous abortions (RSA) and two neonatal deaths. Comparative genomic hybridization (CGH) was used to determine the chromosomal composition of the patient's last miscarriage. It showed the presence of monosomy for the distal end of chromosome 2 long arm (segment 2q37.2 to qter) and trisomy for the distal end of chromosome 17 long arm (segment 17q25 to qter). The mother was found to be a carrier for a cryptic translocation between chromosomes 2 and 17 long arms by fluorescence in situ hybridization using a subtelomeric probe for 17q. Retrospective CGH analysis on one baby who died neonatally showed that he had inherited the maternal translocation in the same unbalanced state as the last pregnancy loss. His detailed postmortem examination is reported.

Abortion, Habitual↗