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PubMed2007

Medical history, cigarette smoking and risk of acoustic neuroma: an international case-control study.

Acoustic neuroma (vestibular schwannoma) is a benign tumor of the vestibulocochlear nerve. Its recorded incidence is increasing but risk factors for this tumor have scarcely been investigated. We conducted a population-based case-control study of risk factors for acoustic neuroma in the UK and Nordic countries, including 563 cases and 2,703 controls. Tumor risk was analyzed in relation to medical history and cigarette smoking. Risk of acoustic neuroma was significantly raised in parous compared with nulliparous women (OR = 1.7, 95% CI: 1.1-2.6), but was not related to age at first birth or number of children. Risk was not associated with a history of allergic disease, past head injury, past diagnosis of a neoplasm or birth characteristics, but was significantly raised for past diagnosis of epilepsy (OR = 2.5, 95% CI: 1.3-4.9). Tumor risk was significantly reduced in subjects who had ever regularly smoked cigarettes (OR = 0.7, 95% CI: 0.6-0.9), but the reduction applied only to current smokers (OR = 0.5, 95% CI: 0.4-0.6), not ex-smokers (OR = 1.0, 95% CI: 0.8-1.3). The reduced risk of acoustic neuroma in smokers and raised risk in parous women might relate to sex hormone levels, or smoking might suppress tumor growth, but effects of parity and smoking on timing of diagnosis of the tumor are also a potential explanation. The raised risk in relation to past diagnosis of epilepsy might be a surveillance artefact or imply that epilepsy and/or antiepileptic medication use predispose to acoustic neuroma. These findings need replication by other studies and possible mechanisms need to be clarified.

Adolescent↗
PubMed2007

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↗
PubMed1981

Dietary factors and breast cancer risk.

As part of a case-control study in northern Alberta, Canada, 577 women aged 30-80 with breast cancer diagnosed during 1976-77 and a population-based age-stratified random sample of 826 disease-free female controls were questioned about certain aspects of their diet. Computing relative risks (RRs) by tertiles, significant increasing trends were found with more frequent consumption of beef (RRs of 1.0, 2.3, 1.5; test for trends, p less than 0.001), pork (RRs of 1.0, 1.6, 2.2; test for trend, p less than 0.001), and sweet desserts (RRs of 1.0, 1.3, 1.5; test for trend, p = 0.01). Elevated risks were also noted for use of butter at the table and for frying with butter or margarine, as opposed to vegetable oils. The association of total beef and pork consumption with breast cancer was not materially affected by controlling for age at first birth, family history of breast cancer, previous benign breast biopsy or socioeconomic status. Nor was the association reduced by controlling for ages of menarche and menopause, even though within the control series the intake of beef and pork reported in adult life was higher among those with a lower age at menarche or a older age at natural menopause.

Adult↗
PubMed1986

Parity and breast cancer risk: possible effect on age at diagnosis.

We examined the effect of parity on breast cancer risk on the basis of information from 107,146 married female nurses followed prospectively between 1976-1980. For everparous women, a significant protective effect against breast cancer was observed with increasing parity (chi 12 for trend = 14.2, p less than 0.001). Adjustment for age at first birth and other potential confounders by multiple logistic regression did not materially affect this trend. After controlling for these risk factors, the overall relative risk of breast cancer for women with four or more pregnancies lasting 6 months or longer was 0.68 (95% confidence limits 0.51-0.90) compared with women with only one pregnancy. When nulliparous and everparous women were compared, an interaction of age and everparous status in 1976 was observed. The logistic regression coefficient for the interaction was 0.3419 (95% confidence limits 0.0374-0.6464). Specifically, for women of parity 2 relative to nulliparous, the relative risk of breast cancer and the 95% confidence intervals were 1.85 (1.09, 3.14), 1.32 (0.92, 1.89), and 0.93 (0.62, 1.41) for 30-39, 40-49 and 50-55-year-old women, respectively. This points to the need of presenting age-specific, rather than age-adjusted, relative risks in future studies of breast cancer and parity.

Adult↗
PubMed1990

Number of children and death from hormone-dependent cancers.

The association between number of children of current marriage reported by 431,604 women aged 45-74 years at the Norwegian Census in 1970 and mortality, at follow-up through 1985, from hormone-dependent cancers, i.e., cancers of breast, corpus uteri and ovary combined, has been investigated. The reduction in age-adjusted mortality was 9.6% (95% confidence interval; 8.3-10.9%) for each child with no deviation from linearity. Women with 8-11 children had a relative risk of 0.34 (0.25-0.47) compared to nullipara. Adjustment for age at first birth slightly changed the effect of number of children on mortality to 9.3% per child. The reduction in mortality per child was for cancer of the breast 7.2%, corpus uteri 12.2% and ovary 12.7%. Our findings indicate that having few children is a major risk factor for death from the 3 hormone-dependent cancers combined.

Age Factors↗
PubMed1992

Risk factors for cervical cancer in Colombia and Spain.

A population-based case-control study of cervical cancer was conducted in Spain and Colombia to assess the relationship between cervical cancer and exposure to human papillomavirus (HPV), selected aspects of sexual and reproductive behaviour, use of oral contraceptives, screening practices and smoking. The study included 436 cases of histologically confirmed squamous-cell carcinoma and 387 age-stratified controls randomly selected from the general population that generated the cases. The presence of HPV DNA in cervical scrapes was assessed by PCR-based methods and was the strongest risk factor (OR = 23.8; 13.4-42.0). Risk estimates for any other factor were only slightly modified after adjusting for HPV status. Among women found positive for HPV DNA, only the use of oral contraceptives was a risk factor for cervical cancer (OR = 6.5; 1.3-31.4 for ever vs. never use). Patients with cervical cancer who were HPV DNA-negative retained most of the established epidemiological features of this disease. This suggests that some instances of HPV infection went undetected or that other sexually transmitted factor(s) contribute to the causation of cervical cancer. Early age at first intercourse (OR = 4.3; 2.1-9.0 for age < 16 vs. 24+) and early age at first birth (OR = 5.0; 1.8-14.2 for age < 16 vs. 24+) were associated with increased risk of cervical cancer; these effects were independent of one another. Low educational level was a risk factor (OR = 2.5; 1.6-3.9). Number of sexual partners was in our study a surrogate for HPV infection. Smoking and parity after age 24 were weakly and inconsistently associated with the risk of cervical cancer. Previous screening (OR = 0.7; 0.5-1.0) and ever having undergone a Caesarean section (OR = 0.4; 0.2-0.8) were protective factors.

Age Factors↗
PubMed1993

Reproductive variables, tobacco, ethanol, coffee and somatometry as risk factors for ovarian cancer.

A hospital-based case-control study of ovarian cancer was conducted in Athens from 1989 to 1991. The cases were 189 women, residents of Greater Athens and less than 75 years old, with histologically confirmed common malignant epithelial tumors of the ovary, operated in the 2 major cancer hospitals of the Greater Athens area. Controls were women residents of Greater Athens, less than 75 years old, who had never had cancer or had an ovary removed and who had visited patients hospitalized in the same wards as the ovarian cancer cases at the same time. The data were analyzed by modeling through multiple logistic regression. Statistically significant associations were found with induced menopause without oophorectomy [relative risk (RR) 0.17; 95% confidence interval (CI) 0.04 to 0.72], age at menopause (for an increment of 5 years RR 1.42; CI 1.00 to 2.01), hormone-replacement therapy (RR 5.73; CI 1.07 to 30.80), parity (RR 0.48; CI 0.24-0.96) and, marginally, age at first birth (for an increment of 5 years RR 1.30; CI 0.99 to 1.70). Non-significant but previously suggested or biologically plausible associations were noted with use of oral contraceptives (inverse), weight before onset of the disease (positive), and consumption of more than 2 glasses of alcoholic drinks per day (positive). There were no consistent associations with coffee, tobacco, moderate alcohol intake, broad occupational group, induced abortions, or age at menarche.

Adult↗
PubMed1993

Parity and hepatocellular carcinoma. A population-based study in Sweden.

The association between parity and hepatocellular carcinoma (HCC) was studied using a data-base generated by linking 2 Swedish nation-wide registries; the Cancer Registry and the Fertility Registry. Among women born between 1925 and 1960, 133 patients with HCC recorded in the Cancer Registry between 1958 and 1984 were compared with 665 age-matched controls. In this nested case-control study there was no positive association between parity, age at first birth or frequency of twinning on the one hand, and risk of HCC on the other. It appears that the positive association between parity and HCC previously reported is limited to cases of HCC caused by chronic infection with hepatitis B virus; these cases represent only a small fraction of HCC cases in Sweden.

Adult↗
PubMed1995

Reproductive and other factors and risk of epithelial ovarian cancer: an Australian case-control study. Survey of Women's Health Study Group.

Of the few factors known to be associated with epithelial ovarian cancer, the most consistently observed relate to women's reproductive function, although even here uncertainties remain. We have undertaken a case-control study involving personal interviews with over 1,600 women, the largest of its kind to date, to investigate further the associations between women's reproductive histories and other factors and the development of ovarian cancer. Cases were drawn from women diagnosed with epithelial ovarian cancer in 3 Australian states, Queensland, New South Wales and Victoria, between August 1990 and December 1993, and controls were drawn at random from the electoral roll, stratified by age and geographic region. Trained interviewers administered standard questionnaires to obtain detailed information about women's reproductive and contraceptive histories and other factors of interest, such as smoking and family history of ovarian or other cancer. Findings were based on data from 824 cases and 860 controls and confirmed the reduced risk of ovarian cancer associated with increasing parity and duration of use of the oral contraceptive pill (OCP), hysterectomy and tubal ligation. The strongest association of all was seen with use of the OCP for 10 years or more. An inverse association between ovarian cancer and age at first birth was observed, but this was not statistically significant. There were no associations between development of ovarian cancer and number of incomplete pregnancies, use of hormone replacement therapy or menstrual history. Among other factors considered, education after leaving school was negatively associated and high body mass index, family history of ovarian cancer, use of talc in the abdominal or perineal region and smoking were positively associated with occurrence of ovarian cancer.

Adolescent↗
PubMed1999

Epidemiologic differences between women with borderline ovarian tumors and women with epithelial ovarian cancer.

OBJECTIVE: The aim of this study was to study the relationship between borderline ovarian tumors (BLOT) and epithelial ovarian cancer (EOC) by comparing the epidemiologic features of women with BLOT with those of women with EOC of similar histology. MATERIAL AND METHODS: The epidemiologic features of 32 women with serous and mucinous BLOT were compared with those of 273 women with primary serous or mucinous EOC. We included all women with the documented respective histologic diagnoses admitted to Roswell Park Cancer Institute between 1982 and 1996 who returned a self-administered epidemiologic questionnaire which contained 44 items pertaining to reproductive, contraceptive, medical, social, dietary, occupational, and family histories of cancer. Individual variables between both groups were compared using the Student t test, chi2 analysis, the Mantel-Haenszel test, and the Wilcoxon nonparametric test. Two-tailed P < 0.05 was considered significant. RESULTS: The response rate to the questionnaire was 63% in the BLOT group and 60% in the EOC group. There was no significant difference between the two groups in geographic location, race, education, income, smoking, marital status, age at first pregnancy, age at first birth, history of hysterectomy, history of infertility, history of tubal surgery, use of hormone replacement therapy, or history of diaphragm or intrauterine contraceptive device use. There were no significant differences in family history of malignancy between women with BLOT and those with EOC. Women with BLOT were significantly younger than those with EOC (mean age 47 +/- 14.0 versus 56 +/- 13.7, P < 0.01). There was an apparent difference in oral contraceptive pill use between both groups. However, when we adjusted for age by stratification this difference was not significant (P = 0.089). CONCLUSIONS: The epidemiologic features of women with BLOT are similar to those of women with EOC with the exception of an earlier age of onset. These findings might be consistent with one etiology for both conditions.

Adenocarcinoma, Mucinous↗
PubMed2001

Risk factors for epithelial borderline ovarian tumors: results of a Swedish case-control study.

OBJECTIVE: Borderline ovarian tumors have a favorable prognosis. Previous epidemiological studies indicate common risk factors for invasive epithelial ovarian cancers and borderline tumors, but it remains unresolved whether these tumors are precursors of invasive cancers or a separate disease entity. The objective of this population-based case-control study conducted in 1993-1995 was to examine reproductive and other factors in relation to the risk of borderline ovarian tumors. METHODS: Subjects were 193 histologically verified incident epithelial borderline tumor cases and 3899 randomly selected controls aged 50-74 years, whose data were collected through mailed questionnaires. Risk estimates were calculated by unconditional logistic regression. RESULTS: Ever parous women were at reduced risk, with odds ratios of 0.44 (95% confidence interval (CI) 0.26-0.75) for serous and 0.63 (95% CI 0.34-1.19) for mucinous tumors. No clear trends emerged for age at first birth, at menarche, and at menopause. Lactation reduced tumor risk. Oral contraceptive ever use conferred no protection, with odds ratios of 1.40 (95% CI 0.87-2.26) for serous and 1.04 (95% CI 0.61-1.79) for mucinous tumors. The odds ratio for serous tumors following unopposed estrogen ever use was 2.07 (95% CI 1.08-3.95), whereas no risk increase appeared with estrogens supplemented by cyclic or continuous progestins. Mucinous tumors were not associated with hormone replacement therapy. The odds ratio for serous tumors in the highest category of body mass index was 6.47 (95% CI 3.09-13.5). CONCLUSIONS: Increasing parity and lactation reduce the risk of borderline ovarian tumors in women aged 50-74, while no protection follows oral contraceptive use. Hormonal situations such as unopposed estrogen use and obesity, where estrogens are not counteracted by progestins, may increase the risk of serous tumors.

Aged↗
PubMed1996

Incidence of breast cancer in Norwegian female radio and telegraph operators.

Exposure to electromagnetic fields may cause breast cancer in women if it increases susceptibility to sex-hormone-related cancer by diminishing the pineal gland's production of melatonin. We have studied breast cancer incidence in female radio and telegraph operators with potential exposure to light at night, radio frequency (405 kHz-25 MHz), and, to some extent, extremely low frequency fields (50 Hz). We linked the Norwegian Telecom cohort of female radio and telegraph operators working at sea to the Cancer Registry of Norway to study incident cases of breast cancer. The cohort consisted of 2,619 women who were certified to work as radio and telegraph operators between 1920 and 1980. Cancer incidence was analyzed on the basis of the standardized incidence ratio (SIR), with the Norwegian female population as the comparison group. The incidence of all cancers was close to unity (SIR = 1.2). An excess risk was seen for breast cancer (SIR = 1.5). Analysis of a nested case-control study within the cohort showed an association between breast cancer in women aged 50+ years and shift work. In a model with adjustment for age, calendar year, and year of first birth, the rate ratio for breast cancer associated with being a radio and telegraph operator--in comparison with all Norwegian women born 1935 or later--analyzed with Poisson regression, was 1.5 after adjustment for fertility factors. These results support a possible association between work as a radio and telegraph operator and breast cancer. Future epidemiologic studies on breast cancer in women aged 50 and over, should address possible disturbances of chronobiological parameters by environmental factors.

Adult↗
PubMed1993

Reduced breast cancer mortality among fishermen's wives in Norway.

International comparisons show that populations having a high consumption of fish experience low incidence of breast cancer. We compared death rates from breast cancer among socioeconomic groups in a prospective study of 533,276 Norwegian women aged 35-54 years who were followed from 1970 through 1985. Compared with the reference group (wives of unskilled workers) the fishermen's wives had a decreased risk of breast cancer with a relative risk (RR) of 0.67 (95% confidence interval [CI] = 0.47-0.94) adjusted for age and the number of children. Among fishermen's wives who were parous, adjustment for age at first birth gave an RR of 0.62 (CI = 0.43-0.91). This study supports the hypothesis that certain aspects of diet, i.e., fish consumption, may be associated with lower breast-cancer mortality.

Adult↗
PubMed1993

Reproductive factors and risk of brain, colon, and other malignancies in Iowa (United States).

The influence of parity on the risk of cancers of the female breast and reproductive organs is well established. However, non-reproductive sites have received less attention. Mail questionnaire data gathered from incident female cases (169 brain; 332 colon; 260 rectal; 145 kidney; and 169 pancreas cancers), and 821 population-based controls in Iowa (United States) were used to measure the effect of parity and age at first birth on risk of these malignancies. Relative to nulliparous women, ever-parous women were at significantly decreased risk of brain cancer (odds ratio [OR] = 0.44, 95 percent confidence interval [CI] = 0.3-0.7) and of colon cancer (OR = 0.67, CI = 0.5-0.97), after adjustment for age and other risk factors. The OR for the other sites did not differ significantly from 1.0. The lower risk of brain cancer among parous women was similar in younger and older age groups, in patients diagnosed with glioblastoma and astrocytoma, and among ever- and never-smokers. The findings for colon cancer are consistent with observations from other studies. In the context of limited laboratory and clinical evidence implicating hormones in brain neoplasia, these findings may suggest a role for hormonal factors in brain cancer etiology. Hormonal factors deserve more detailed future consideration as risk factors in brain cancer.

Adult↗
PubMed1989

Risk factors of female cancers in Ragusa population (Sicily). 2. Breast cancer.

A case-control study on breast, cervix and corpus uteri cancer cases registered in Ragusa between January 1, 1983 and June 30, 1985 has been conducted. Information on risk factors has been obtained by means of a structured questionnaire. Risk factors for breast cancer were: few pregnancies (1-2 vs greater than 4 OR 2.14, 95% CL 1.13-4.04), few children (for postmenopausal only, chi trend 4.84), previous breast disease (OR 1.97, 95% CL 1.20-3.23), family history (OR 3.57, 95% CL 1.92-6.63), alcohol (OR 1.68, 95% CL 1.12-2.53), high socioeconomical status (1 vs 4 OR 2.93, 95% CL 1.22-70.03). A protective role was evident for: early age at first birth (for premenopausal only, less than 20 vs greater than 20 OR 0.11, 95% CL 0.01-0.90), previous ovary disease (OR 0.26, 95% CL 0.08-0.88). Age at menarche, age at menopause, years of fertile life and breast feeding were not found to be related to breast cancer. A different distribution of risk factors among cases with and without family history has been suggested. A synoptic table shows the distribution of the most important risk factors of the three investigated female cancers in the Ragusa population, reported in the present and in an accompanying paper.

Adult↗
PubMed1992

Reproductive factors, exogenous female hormones, and colorectal cancer by subsite.

The associations between reproductive factors, exogenous hormones, and colorectal cancer were examined among female subjects in a population-based case-control study in Sweden. The study was performed in Stockholm in 1986-88, and included 299 cases and 276 controls. There was little evidence that age at first birth, number of months of breast feeding, age at menarche, or age at menopause influenced the risk of colon or rectal cancer. However, the results indicate that postmenopausal hormone-replacement therapy might reduce the risk of colorectal cancer (age-adjusted relative risk [RR] = 0.4, 95 percent confidence interval [CI] = 0.2-0.9). Compared with nulliparous women, women with at least four births were at reduced risk for colon cancer (RR = 0.5, CI = 0.2-1.2) but not rectal cancer (RR = 1.0, CI = 0.4-2.6). However, no trend across increasing parity was observed. Adjustments for diet, body mass, and physical activity had little influence on the results.

Age Factors↗
PubMed1984

Hormonal factors in human carcinogenesis.

A synopsis is presented of hormone-cancer relationships as seen by an epidemiologist. Emphasis has been placed on reproductive risk factors and cancers of the endometrium, ovary and breast. Although there are definite parallelisms in this regard the aetiological mechanisms for these three sites may be different. Evidence is accumulating that the protective effect of an early first birth and of subsequent pregnancies on breast cancer risk can be understood biologically in terms of interference with the occurrence of preneoplastic lesions.

Breast Neoplasms↗
PubMed1986

Felix A. Theilhaber--pioneer sexologist.

Felix A. Theilhaber, a physician, was born in Germany in 1884 and died in Israel in 1956. He was a pioneer sexologist, demographer, and sportsman and an early Zionist. Theilhaber was an original thinker and a prolific writer. He fought courageously against the pervasive reactionary and antisocial attitudes in the Germany of his time and campaigned actively, in his public addresses, books, pamphlets, and papers, for sexual reform, especially for liberalization of abortion and legalization of contraception. He founded the Society for Sexual Reform (Gesex) in 1913 and was cofounder and sexologic adviser of one of the first birth control and sex advisory clinics in Berlin (1930), operating under the patronage of the Gesex. In 1925, he founded the Coalition for Reform of the (Germany) Criminal Law, and in 1928, the periodical Sexual Hygiene. Among 20 books authored by Theilhaber are The Decline of the German Jews (1911), Das Sterile Berlin (1913), and Goethe, Sexus and Eros (1929). After his emigration to Israel in 1935, he continued his writings and later founded a Health Insurance Company in Tel Aviv, acting as its medical director. He has left a great legacy for sexology.

Abortion, Legal↗