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PubMed1992

Sex steroid hormones and breast cancer: is there a link with oral contraceptives and hormone replacement therapy?

OBJECTIVE: To determine whether use of sex steroid hormones for contraception and hormone replacement therapy alters the risk of breast cancer, and whether the risk varies with their composition, duration of use, the period of a woman's life when the hormones are used, and after successful treatment for breast cancer. DATA SOURCES: The results of important epidemiological reports, readily available from the English literature and published since 1981, were evaluated, using reports of basic scientific work as a background to the problem. STUDY SELECTION: An attempt was made to obtain most of the relevant reports. Twenty case-control and seven cohort studies were available on the oral contraceptive pill (OCP) and eleven case-control and five cohort studies on hormone replacement therapy (HRT). DATA EXTRACTION: The relative risk estimates for breast cancer (and their 95% confidence intervals) determined by each report were tabulated according to the specific conditions of analysis, for example users under age 25, duration of use. Results by meta-analysis from previous studies were also used to determine risk. A significant positive association was present when the risk estimate exceeded 1.0 and the 95% confidence interval did not cross 1.0. DATA SYNTHESIS: Among OCP users, the vast majority of reports showed no significant risk of breast cancer--overall, longest duration of use, and use before first full-term pregnancy. However, a positive association between breast cancer and users under age 25 was found in three of eight reports. Similarly, the majority of reports showed no significant risk of breast cancer among HRT users, overall as well as in relation to duration of use and interval since first use. There was no increased risk with additional progestogen; it may be protective. An improved prognosis was found in users who developed breast cancer. On the limited data, use of hormones for postmenopausal symptoms did not appear to be harmful to women who had been successfully treated for breast cancer. CONCLUSIONS: The review revealed good evidence that use of sex steroid hormones had no significant effect on the risk of breast cancer, whether given for contraception or hormone replacement. There was some concern about increased risk with prolonged use of the OCP, especially in younger women. At present, use of these hormones is a matter of informed choice, with individual considerations of the risk-benefit ratio.

Adult↗
PubMedDate not supplied

Family planning clinics: facing higher costs and sicker patients.

Family planning clinics throughout the United States are facing a variety of obstacles that threaten their ability to provide necessary contraceptive services to low-income women and teenagers, according to interviews with clinic administrators. In the last few years, the proportion of patients coming to family planning agencies in need of screening or treatment for sexually transmitted diseases (STDs) has increased dramatically. Many providers report that 10-15 percent of their clients are infected with chlamydia, the most prevalent STD. The increasing costs of Pap tests and contraceptives are also major problems: As a result of recent federal legislation, the price of Pap tests has risen substantially, and that of contraceptives is beginning to increase steeply. Finally, Title X funding for family planning services has decreased 66 percent over the last decade if both cuts and inflation are taken into account. As a result of the squeeze between increased costs and decreased public funding, clinics have been forced to charge higher fees, maintain long waiting lists for appointments and curtail community outreach. In addition, growth of the family planning patient population has slowed dramatically, and even declined, in some places.

Cost Control↗
PubMed1988

Risk factors for breast cancer in Chinese women in Shanghai.

Five hundred thirty-four histologically confirmed incident cases of breast cancer in Chinese women of Shanghai and an equal number of age and sex-matched population controls were interviewed as part of an epidemiological study of breast cancer risk factors. Early age at menarche was positively associated with breast cancer risk whereas early age at first full term pregnancy, high parity, and long duration of nursing were each negatively associated. We found high average body weight to be a risk factor, especially among women over age 60. Use of oral contraceptives after age 45 also was a risk factor, but use in general was not. Personal history of benign breast disease and history of breast cancer in first degree female relatives both increased risk. Multivariate analysis showed that each of these risk (or protective) factors was independently related to breast cancer. In addition to confirming most of the breast cancer risk factors of Western populations in a low risk developing Asian country, this study demonstrates a clear beneficial effect on breast cancer risk of lactation in a population characterized by a long cumulative duration of nursing in the majority of women. Finally, this study supports several other recent reports of a residual and beneficial effect of parity on breast cancer risk after controlling for age at first full term pregnancy.

Abortion, Spontaneous↗
PubMed1988

Recent decline in gonorrhea incidence in Israel: possible association with the AIDS pandemic.

The effect of the AIDS pandemic on the sexual behavior of the general population has not been clearly established. Since trends in the incidence of other sexually transmitted diseases may be a good marker of such behavioral changes, gonorrhea incidence in the civilian and military populations in Israel was examined during the period 1963-87. In the civilian population, the rates were relatively stable until 1967, when they increased to a peak in 1970 and then declined to the earlier levels. In 1982 a further decline began, which accelerated considerably in 1986 when the rates declined by 38%. During 1987 the decline was even more dramatic, with a drop of 60% compared with the rate of the previous year. A similar trend has been noted in the military population. The recent sharp decline in gonorrhea incidence may be related, at least partly, to a change in sexual behavior associated with the fear of AIDS. If so, its magnitude suggests that such changes have not been restricted to high-risk groups.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Cancers of the cervix uteri and breast: changes in incidence rates in Bombay over the last two decades.

The age-adjusted incidence rate of cervical cancer in Bombay has decreased over the last 20 years, whereas over the same period that of breast cancer increased slightly. Studies indicate that the incidence of cervical cancer is lower in successively later-born cohorts, but no cohort effect has been observed for breast cancer. Age at marriage is an important factor in the etiology of both these cancers, and it is plausible that the decrease in cervical cancer has resulted from the increase in age at marriage of women over the last 20 years in the city. The changing pattern of incidence of cancer for women in Bombay, among whom the incidence of breast cancer is the highest of all forms of cancer, indicates that, from a long-term perspective, cancer control programmes in India as a whole should aim at minimizing the risk of both cervical and breast cancer.

Adult↗
PubMed1987

Lactation and reproduction in Western Australian women.

There has been an increase in the incidence of breast-feeding in industrial areas, particularly in Western Australia, where one in four infants is breast-fed into the second year of life. Most of this increase in the incidence of breast-feeding is found in the higher socio-economic groups, pointing to a need to collect data on milk yield in such women. The levels of milk yield in women with infants between 1 and 6 months ranged from a mean of 1.13-1.24 kg/24 h. This is a higher level of milk production than the generally accepted range of 0.7-0.9 kg/24 h. However, this difference is due, in part, to a failure of previous test weighing methods to correct for the evaporative water losses in either the infant or mother. There was no relationship between the introduction of solids and a return to fertility in 38 women breast-feeding on demand. The return of the ovulatory menstrual cycle in women resulted in two acute changes in milk composition. These changes were characterized by a rise in the concentration of sodium and chloride and a fall in the concentration of potassium, glucose and lactose in breast milk. The first change occurred five to six days before ovulation, and the second occurred six to seven days after it. Following the cessation of breast-feeding, the concentration of lactose in breast milk gradually declined, but the concentrations of anti-bacterial proteins (IgA and lactoferrin) gradually increased to high levels over a period of 30-40 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMedDate not supplied

Trends in sexually transmitted disease incidence in Papua New Guinea.

A retrospective study of gonorrhoea and syphilis from Health Department records was carried out in Papua New Guinea. During the ten-year period (1974-1983) 101,636 new cases of gonorrhoea and 34,422 of syphilis were reported among the general population of Papua New Guinea. The incidence of both sexually transmitted disease have significantly (P less than 0.005) increased over the decade despite the introduction and implementation of the National Sexually Transmitted Disease (STD) Control Programme. Some which contribute to the present increase in sexually transmitted diseases are segregation of health and non-health services, insufficient staff training and increased immigration to urban centres.

Adolescent↗
PubMedDate not supplied

Immunization with oral poliovirus vaccine in China.

China began to produce oral, live poliovirus vaccine ( OPV ) in 1960. During 1960-1964, OPV was introduced in major cities only and subsequently was used throughout the country. Since that time the incidence of poliomyelitis has dropped dramatically, and the percentage of the healthy population with antibody has clearly risen. Data from many observations showed a high rate of isolation of other enteroviruses in the healthy population and in individuals with poliomyelitis. These findings indicate that some paralytic cases may be caused by other enteroviruses. Localized outbreaks of poliomyelitis still occur, however, and their elimination will require a campaign to ensure that greater than 90% of susceptible individuals are immunized.

China↗
PubMed1994

Changing scenario of birthweight in south India.

Reducing incidence of low birthweight and increasing mean birthweights are now considered seriously in the national action plans. Comparison of birthweights obtained over two decades from the representative random segments of rural and urban areas of North Arcot Ambedkar district, Tamil Nadu, India, were studied. Although statistically significant (p < 0.001), the mean birthweight shows only a marginal increase of 70 g from 2774.5 g (+/- 500.2) in 1969-73 to 2845.4 g (+/- 451.0) in 1989-93. The mean birthweight stratified by area and gender also revealed similar increase. On the other hand, the proportion of low birthweight (< 2500 g) newborns reduced significantly from 27.2% to 15.9% in rural and 19.1% to 10.8% in urban area over the decades (p < 0.001). The increase in the mean birthweight and the decline in the percentage of low birthweight newborns over the years was greater in rural than the urban community, but the rural newborns continued to weigh lesser than their urban counterparts.

Adolescent↗
PubMed1993

Perinatal mortality in caesarean section: a disturbing picture of unfulfilled expectations.

Indications for caesarean section had been studied in a 2-year period and the incidences were compared to that of the same 15 years back. Though there are more incidences of caesarean section, still perinatal death is a major concern to all. The study included a total of 291 perinatal deaths of which there were 208 early neonatal deaths and 83 stillbirths over a period of 2 years from January, 1990 to December, 1991. Caesarean section is being increasingly performed for foetal interest, but this study reveals that perinatal mortality is still high though cesarean section rate has increased in recent times.

Cesarean Section↗
PubMed1993

A 13-year follow-up of treatment and snail control in an area endemic for Schistosoma mansoni in Brazil: incidence of infection and reinfection.

The incidences of Schistosoma mansoni infection and reinfection were investigated in an endemic area of Brazil (Peri-Peri, State of Minas Gerais) where chemotherapy and snail control had been used for 13 years (1974-87). Two cohorts were followed: the first consisted of 584 individuals with no evidence of infection at entry (infection cohort), and the second comprised 296 individuals who were treated and did not eliminate eggs 8-12 months afterwards (reinfection cohort). The incidence of infection (per 100 person-years) decreased from 7.5 in 1974-77 to 3.6 in 1986-87, and that of reinfection from 21.3 in 1974-77 to 3.7 in 1986-87. Calendar period, age at risk, and sex were independently associated with both infection and reinfection, while a heavy S. mansoni egg count prior to treatment (> or = 500 epg (eggs per gram of stools)) was independently associated with reinfection. The geometric mean number of eggs after treatment among those reinfected (47 epg) was approximately half that among those infected for the first time (81.5 epg). Age at risk had the greatest effect on both infection and reinfection. The rate ratios of infection and reinfection were 3 to 6 times higher among individuals younger than 20 years than among those aged > or = 25 years, even after adjusting for confounders. This suggests the existence of a strong protective effect with increased age (because of biological and/or environmental factors) for both infection and reinfection.

Adolescent↗
PubMed1996

Epidemiology of HIV and AIDS in the Asia-Pacific region.

The incidence of new HIV infections in Asia and the Pacific will soon pass that in Africa and is projected to increase into the next century. The AIDS epidemic arising from these infections will have enormous consequences for the health and socioeconomic development of a region encompassing more than half the world's population.

Acquired Immunodeficiency Syndrome↗