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  • 1
    ISSN: 1573-7217
    Keywords: breast neoplasms ; therapy ; colorectal neoplasms ; estrogen antagonists ; estrogen replacement therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The increasingly consistent association between estrogen replacement therapy and colorectal cancer suggests that the anti-estrogen tamoxifen may also be associated with large bowel cancer incidence. Methods: Women with new diagnoses of breast cancer were identified from the Surveillance Epidemiology and End Results (SEER) Program, a set of geographically defined, population based cancer registries representing approximately ten percent of the U.S. population. Of 85,411 women with local or regional breast cancer diagnosed from 1983–90, 14,984 women were reported to have received hormonal therapy and 70,427 were not known to have received hormonal therapy. Subsequent cancer diagnoses were identified in this cohort beginning 6 months after initial breast cancer diagnosis until death, or December 31, 1994. Multivariate Cox proportional hazards models were used to estimate the risk of developing colorectal cancer and other second cancers according to hormonal therapy use. Results: Over the follow-up period 793 colorectal, 2,648 contralateral breast, 506 endometrial, 250 ovarian, 98 gastric, and 1,765 other cancers were identified in the study cohort. While overall there was no association between hormonal therapy use and colorectal cancer (relative risk (RR) 1.09, 95% confidence interval (CI) 0.88–1.35), in the period five or more years after diagnosis, risk was increased significantly by about 50% (95% CI 1.00–2.15). As expected, based upon clinical trials data, cancers of the contralateral breast were significantly decreased, and cancers of the uterine endometrium were significantly increased. No other meaningful associations were observed. When women were excluded for whom hormonal therapy might represent therapy other than tamoxifen (premenopausal women and those who received chemotherapy), this did not meaningfully alter these estimates. Conclusions: The results of this large population based cohort study suggest that tamoxifen therapy may modestly increase risk of large bowel cancer in women, but only after 5 years following initiation of breast cancer therapy.
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  • 2
    ISSN: 1573-7225
    Keywords: age ; breast density ; hormone replacement therapy ; mammography ; reproduction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: We determined the association of certain reproductive and hormonal factors with breast density over decades of life. Methods: Subjects were women age 20–79 years who had a screening mammogram between 1 June 1996 and 1 August 1997, in Seattle, Washington. Women with increased breast density (upper two categories of BI-RADS terminology) (n = 14,432) were compared to those with fatty breasts (lower two categories (n = 14,552). Unconditional logistic regression was used with adjustment for age at mammogram, parity, age at first birth, menopausal status, current use of hormone replacement therapy (HRT), and body mass index. Results: The association of nulliparity with density was evident for women at all ages (odds ratio (OR) and 95% confidence interval (CI) = 1.5 (1.3–1.7) and 1.6 (1.4–1.9) for women age ≤45 and 〉65, respectively). Older age at first birth was more strongly associated with density among women 〉55 than among younger women. The association of current use of HRT with density, but not of former use, increased with age when compared to never users (OR = 1.4 (1.2–1.7) and 2.2 (2.0–2.5) for women age 46–55 and 〉65, respectively). Conclusions: Results suggest that pregnancy at an early age has a permanent beneficial association with density, while HRT has a transitory adverse association.
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  • 3
    ISSN: 1573-7225
    Keywords: Cohort effects ; incidence ; melanoma ; registries ; SEER ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: The incidence of malignant melanoma has been increasing steadily in the United States. The increase may be due to lifestyle changes in subsequent generations or birth cohorts. The nine population-based tumor registries in the Surveillance, Epidemiology, and End Results program (SEER) have been in existence for a sufficient time to begin to investigate cohort trends for the US population. Cases were the 18.787 Caucasians aged 20 to 84 years, who reported to SEER registries with a diagnosis of melanoma in 1974–86. Among men born between 1890 and 1919, each subsequent five-year birth cohort experienced 45 to 57 percent increases in age-adjusted melanoma incidence of the arm and trunk, and 14 to 20 percent increases were experienced across each site (arm, leg, head, and trunk) for the 1920–44 cohorts of men. Among women born between 1890 and 1919, 24 to 29 percent increases were seen for melanoma of the trunk, arms, and legs for each subsequent five-year birth-cohort, followed by six to 29 percent increases in the 1920–44 cohorts. Recent birth cohorts, 1945–64, have shown stabilizing rates, even after an attempt to adjust for the increasing tendency for diagnoses to be made in doctors' offices. Thus, the dramatic birth-cohort effects appear to have ended beginning with those born in 1945. However, melanoma rates will continue to rise until those born after 1945 represent the majority of the population. Furthermore, for the most recent cohorts, the trunk has become the most common site (per square meter of body surface) for men and the second most common site for women. This suggests that some lifestyle change has led to more damaging exposure (e.g., sunburns) of the trunk among recent cohorts than earlier cohorts.
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  • 4
    ISSN: 1573-7225
    Keywords: Alcohol ; alcoholism ; laryngeal cancer ; larynx ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Alcohol consumption is a well-known risk factor for laryngeal cancer. To determine whether alcoholism, as measured by responses to the Michigan alcoholism screening test (MAST), is a risk factor for laryngeal cancer independent of alcohol consumption, we analyzed data from a population-based case-control study. Personal interviews were conducted with 235 patients (81 percent response rate) with laryngeal cancer diagnosed from September 1983 through February 1987, who were residents of the Seattle metropolitan area. A total of 547 controls frequency-matched by age and gender, selected by random-digit dialing, were interviewed (75 percent response rate). When considered in a multivariate model, independent risk factors for laryngeal cancer included: alcohol consumption (42 or more drinks/wk compared with seven or less drinks/wk: odds ratio [OR]=3.1,95 percent confidence interval [CI]=1.2–7.9); cigarette use (40 or more cigarettes/day compared with never-smoked: OR=23.1, CI=9.4–52.6); and weighted positive responses to the MAST (score of five or more compared with score of zero: OR=1.9, CI=1.1–3.4). Possible explanations for the association between alcoholism and laryngeal cancer are that a measure of alcoholism improves the accuracy of assessment of alcohol consumption, that alcoholism is associated with a pattern of alcohol consumption that increases the risk of laryngeal cancer, or that alcoholism may be a marker for host susceptibility to the carcinogenic effects of alcohol.
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  • 5
    ISSN: 1573-7225
    Keywords: Indians/North American ; neoplasms ; survival analysis ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cancer survival among American Indians is worse than among other races in some regions of the United States, but has not been studied among American Indians in Washington state. Our purpose was to evaluate cancer survival among American Indians included in the Seattle-Puget Sound Cancer Registry. We compared site-specific survival among American Indians (n=551) and Whites (n=110,899) diagnosed from 1974 to 1989 for five cancer sites. For all sites except prostate, the distribution of cancer stage at diagnosis for American Indians was not significantly different from the distribution for Whites, and a similar proportion of American Indians and Whites received cancer treatment. After adjustment for age differences between American Indians and Whites, American Indians experienced poorer survival from prostate, breast, cervical, and colorectal cancer. Poorer survival among American Indians persisted after adjustment for differences in cancer stage at diagnosis, lack of cancer treatment, and residence in a non-urban county. The survival experience among American Indians who were recorded as non-American Indians in the cancer registry but whe were listed as American Indians in Indian Health Service records was more favorable than that among persons initially coded as American Indians in the cancer registry. We conclude that cancer survival among American Indians in western Washington is poorer than that among Whites in the same region, and that factors other than age, differences in stage at diagnosis, lack of cancer treatment, and residence in non-urban counties account for this.
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  • 6
    ISSN: 1573-7225
    Keywords: Breast neoplasms ; menopausal status ; second primary neoplasms ; United States ; women
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: To evaluate predictors of contralateral breast cancer risk, we examined data from a nested case-control study of second primary cancers among a cohort of women in western Washington (United States) diagnosed with breast cancer during 1978 through 1990 and identified through a population-based cancer registry. Cases included all women in the cohort who subsequently developed contralateral breast cancer at least six months after the initial diagnosis, but prior to 1992 (n=234). Controls were sampled randomly from the cohort, matched to cases on age, stage, and year of initial breast cancer diagnosis. Information on potential risk factors for second primary cancer was obtained through medical record abstractions and physician questionnaires. Women who were postmenopausal due to a bilateral oophorectomy (i.e., a surgical menopause) at initial breast cancer diagnosis had a reduction in contralateral breast cancer risk compared with premenopausal women (matched odds ratio [mOR]=0.25, 95 percent confidence interval [CI]=0.09–0.68), whereas no reduction in risk was noted among postmenopausal women who had had a natural menopause (mOR=0.90, CI=0.39–2.09). Among postmenopausal women, there was a suggestion of a lower risk associated with relatively high parity (2+). A family history of breast cancer was associated with an increased risk (mOR=1.96, CI=1.22–5.15) and varied little by menopausal status. Having an initial tumor with a lobular component (c.f. a ductal histology) was not related strongly to risk (mOR=1.47, CI=0.79–2.74). The results of the present and earlier studies argue that we have limited ability to predict the occurrence of a contralateral breast tumor. Better predictors will be required before diagnostic and preventive interventions can be targeted to subgroups of patients with unilateral breast cancer.
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  • 7
    ISSN: 1573-7225
    Keywords: Age ; melanoma ; migration ; nevus ; pigmentation ; sunlight ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: A survey to ascertain factors associated with benign melanocytic nevi or moles was conducted among randomly-selected White adults (aged 18 to 50 years) in Washington State (United States). Participants of the telephone interview in 1990–91 were questioned about lifetime places of residence and constitutional factors. Subjects counted raised nevi on their arms at the end of the survey. Logistic regression was used to examine the risk for two or more nevi compared with no nevi. Individuals who resided in warmer areas and lower latitudes than Washington State were at higher risk of having multiple nevi. This association held for residence at birth, during childhood, adolescence, and over lifetime: an odds ratio (OR) of 2.3 (95 percent confidence interval =1.2–4.3) for lifetime average daily maximum temperature of ≥64°F compared with 58.9°F, and similar ORs of 2.1 for adolescence and 1.8 for childhood. These associations remained significant after adjusting for potential confounding effects of constitutional factors and for childhood sunburns as a potential mechanism. Risk of multiple nevi was reduced for both early age at migration and longer duration of stay in Washington. These data are consistent with the importance of childhood and adolescent sun exposure in the etiology of nevi, but also suggest an effect of lifetime sun exposure.
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  • 8
    ISSN: 1573-7225
    Keywords: Breast cancer ; Canada ; estrogens ; progesterone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: All British Columbia (Canada) women under 75 years of age who were diagnosed with breast cancer during 1988–89 were asked to complete a postal questionnaire which included detailed information on menopausal estrogen use. Controls were drawn from the Provincial Voters List, matched by five-year age category to the cases. The present analysis consists of 699 cases and 685 controls who were postmenopausal due to natural causes or to a hysterectomy. There was no overall increase in risk of breast cancer associated with ever-use of unopposed estrogen (odds ratio [OR] = 1.0,95 percent confidence interval [CI] = 0.8–1.3). For estrogen use of 10 years or longer, the relative risk [RR] was 1.6 (CI = 1.1–2.5). The risk estimate for current users was somewhat elevated (OR = 1.4, CI = 1.0–2.0). Compared with women who never used hormone preparations, women who had used estrogen plus progestogen had an RR of 1.2 (CI = 0.6–2.2). Our results suggest that ever-use of estrogen, with or without progestogen, does not appreciably increase the risk of breast cancer. However, long-term and recent use of unopposed estrogen may be associated with a moderately increased risk.
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  • 9
    ISSN: 1573-7225
    Keywords: Case-control studies ; colorectal neoplasms ; estrogen replacement therapy ; menopause ; oral contraceptives ; parity ; USA
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The associations between exogenous hormones, reproductive history, and colon cancer were investigated in a case-control study among women aged 30–62 years. The study was conducted in the Seattle, Washington (USA) metropolitan area between 1985 and 1989 and included 193 incident cases of colon cancer and 194 controls. There was little overall association between colon cancer and oral contraceptive use, parity, age at first birth, hysterectomy or oophorectomy status, or age at menopause. Use of noncontraceptive hormones at or after age 40, most likely hormone replacement therapy (HRT), was associated with decreased risk of colon cancer (adjusted odds ratio [OR]=0.60, 95 percent confidence interval [CI]=0.35–1.01), particularly among women with more than five years of use (OR=0.47, 95 percent CI=0.24–0.91). While results from previous studies have not been consistent, any protective effect of HRT against colon cancer would be important given the continuing debate over its potential risks and benefits.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Cancer causes & control 4 (1993), S. 395-396 
    ISSN: 1573-7225
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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