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Biomedical subjects

D Schottenfeld

Publications and source records attributed to D Schottenfeld.

At least 19 recordsLinked to original sources
PubMed1991

Alcohol consumption and the risk of breast cancer: a report from the Tecumseh Community Health Study.

The relationship between prior alcohol consumption and the risk of breast cancer was studied in 1954 women in the Tecumseh Community Health Study (TCHS) who entered the cohort in 1959-1960 and were followed potentially for 28 years. The mean alcohol consumption at baseline was 0.89 (SD 2.2) oz/week for premenopausal women and 0.85 (SD 2.2) oz/week for postmenopausal women. Only 25% of the cohort consumed more than 0.5 oz of ethanol/week or about 1.6 g/day. The adjusted relative risks (RRs) for breast cancer associated with the use of ethanol vs never drinking were 0.93 (95% CI, 0.40-2.18) for ex-drinkers, 1.08 (95% CI, 0.64-1.82) for 0- less than 1 drink/day, 1.23 (95% CI, 0.49-3.10) for 1- less than 2 drinks/day and 1.12 (95% CI, 0.25-5.01) for greater than or equal to 2 drinks/day. There were only 37 subjects in the group at the highest level of consumption (greater than or equal to 2 drinks/day). There was no significant interaction between alcohol and the period of onset of breast cancer (premenopausal or postmenopausal). In the TCHS, alcohol consumption generally at levels not exceeding 2 drinks/day, was not significantly associated with an increased risk of breast cancer. Although we have found little excess risk associated with alcohol consumption, the wide confidence intervals summarized above are not inconsistent with previously published reports that have suggested a modest positive association.

Adult↗
PubMed1990

Screening of average-risk individuals for colorectal cancer. WHO Collaborating Centre for the Prevention of Colorectal Cancer.

Recent developments in screening, diagnosis and treatment of colon cancer could lead to a reduction in mortality from this disease. Removal of adenomas, identification of risk factors, appropriate application of accurate diagnostic tests, and aggressive anatomic-surgical resection of colon cancers may already be having a favourable impact. Screening of average-risk populations over the age of 50 also offers promise in the control of this important cancer. The disease is of sufficient magnitude to deserve detection at an early stage with better prospects of patient survival, since screening tests with moderate sensitivity and high specificity are available. Flexible sigmoidoscopy and faecal occult blood tests are sufficiently acceptable to be included in case-finding among patients who are in the health care system. The results of current controlled trials involving more than 300,000 individuals for evaluating the impact of screening on mortality from colon cancer are needed before this approach can be recommended for general public health screening of the population. Further research is required to develop better screening tests, improve patient and physician compliance, and answer more definitively critical questions on cost-effectiveness. Mathematical modelling using current and new data can be used to determine the effectiveness of screening in conjunction with recommendations for primary prevention.

Colorectal Neoplasms↗
PubMed1988

Benefits and risks of menopausal estrogen and/or progestin hormone use.

Current evidence is reviewed here on risks and benefits of estrogen and progestin use by peri- and postmenopausal women in relation to the following conditions: endometrial cancer, breast cancer, osteoporosis, and coronary artery disease (CAD). On balance, estrogen therapy appears to be beneficial for menopausal women, as it probably reduces the risks of CAD and osteoporosis, two of the major causes of mortality and morbidity. Although unopposed estrogen therapy increases the risk of endometrial cancer, that cancer is relatively rare and is not fatal in the vast majority of cases associated with estrogen use. Definitive conclusions about the relation of menopausal estrogens to breast cancer cannot be drawn due to inconsistent evidence to date. Although evidence from randomized controlled trials is lacking, biochemical and clinical evidence suggest that progestin supplementation is associated with a reduction in endometrial cancer risk in women taking menopausal estrogens. Progestin supplementation also may augment the beneficial effects of estrogens in providing protection against osteoporosis, although this effect is not yet well established. There is little direct evidence bearing on the relation of menopausal progestins to breast cancer. Although studies of CAD per se are lacking at present, progestins probably unfavorably alter lipoprotein profiles, thereby increasing a user's risk of CAD. Given the relatively high incidence and mortality of CAD in postmenopausal women, any negative effects on CAD risk could potentially counterbalance beneficial effects on other causes. We conclude that estrogen replacement therapy is of potential benefit to postmenopausal women, but that the question of progestin supplementation requires further study, particularly for CAD risk.

Breast Neoplasms↗
PubMed1988

Breast cancer in relation to the occurrence and time of induced and spontaneous abortion.

The authors evaluated whether an induced or spontaneous abortion during the first six months of gestation, particularly if it occurs before the first term pregnancy, increases the risk of breast cancer. Data from a case-control study of women under 70 years of age were used: 3,200 cases of breast cancer were compared with 4,844 controls with nonmalignant nongynecologic conditions. Among both nulliparous and parous women, the risk of breast cancer was not related to the number of induced or spontaneous abortions. After allowance for all identified potential confounding factors, the estimated relative risk for nulliparous women with an induced abortion relative to those who had never been pregnant was 1.3 (95% confidence interval (CI) 0.8-2.2), and for spontaneous abortion, the corresponding estimate was 0.9 (95% CI 0.5-1.5). Among parous women, the estimated relative risks were 1.2 (95% CI 0.9-1.6) for an induced abortion and 0.9 (95% CI 0.8-1.0) for a spontaneous abortion, relative to never having had an abortion of any type. The time of the abortion had little effect: The relative risk estimates were 0.9 (95% CI 0.5-1.4) for induced abortion before the first term birth, 1.4 (95% CI 1.0-1.9) for induced abortion first occurring after the first term birth, 0.9 (95% CI 0.7-1.2) for spontaneous abortion before the first term birth, and 0.9 (95% CI 0.7-1.0) for spontaneous abortion first occurring after the first term birth. Similar results were evident for women under age 40, among whom the frequency of induced abortion was relatively high. These data suggest that the risk of breast cancer is not materially affected by abortion, regardless of whether it occurs before or after the first term birth.

Abortion, Induced↗
PubMed1987

Epithelial ovarian cancer and coffee drinking.

A recent report from a case-control study in Greece suggested that coffee consumption is related to an increase in the risk of ovarian cancer. This hypothesis was examined in a hospital-based case-control study in the US. Information on coffee drinking and other factors was obtained from 290 incident cases of epithelial ovarian cancer and compared with that of 580 controls with non-malignant conditions of acute onset and 476 controls with cancer of other sites. Adjustment was made for the potential confounding effects of several factors, including the major known risk factors for ovarian cancer. The estimated relative risk for drinking five or more cups of coffee per day, relative to none, was 1.1 (95% confidence interval, 0.6-2.0) using the controls with non-malignant conditions and 1.0 (0.5-1.8) using the controls with cancer. The estimates for drinking less than five cups per day were greater than 1.0, but this could have been due to chance. The consumption of decaffeinated coffee and tea also appeared to have no influence on risk. The evidence from this study suggests that, if coffee drinking increases the risk of ovarian cancer, the effect is small.

Adult↗
PubMed1987

Hydralazine and breast cancer.

Hydralazine (CAS: 86-54-4; 1-hydrazinonaphthalazine) is a well-established antihypertensive agent. There are no conclusive data on the drug as a human carcinogen, but one of its metabolites, hydrazine (CAS: 302-01-2), has been shown to be carcinogenic in rats and mice. To assess the relationship of hydralazine to human breast cancer, 3,419 women with breast cancer and 3,219 hospital control subjects were studied. Data were obtained by interview in hospitals in the United States and Canada. A total of 1.4% of the cases and 1.2% of the controls had used hydralazine. Compared with never use, the relative risk (RR) estimate for hydralazine that was first used at least 18 months before admission was 0.9 [95% confidence interval (CI), 0.5-1.7] after risk factors for breast cancer and the use of other antihypertensive drugs and diuretics were taken into account by multivariate analysis. The RR estimate for hydralazine use lasting at least 1 year was 0.9 (95% CI, 0.5-1.7). RR estimates for longer durations of use (up to 5 or more yr), and for use within strata of risk factors for breast cancer, were close to 1.0. The results suggest that hydralazine does not increase the risk of breast cancer in humans in the short term. Whether the risk is increased after latent intervals of many years could not be evaluated.

Adult↗
PubMed1986

Stomach and colorectal cancers in Puerto Rican-born residents of New York City.

Colorectal cancer incidence and mortality rates for Puerto Rican-born residents in New York City (PR-NYC) for 1975-79 were about two times those for Puerto Ricans living in Puerto Rico (PR-PR) and one-half to almost two-thirds those for other whites in New York City. From 1958 to 1979, colon cancer mortality rates for PR-NYC increased dramatically (i.e., 212% in males and 54% in females), whereas in PR-PR, male rates increased only slightly and female rates remained constant. For stomach cancer, incidence rates for male and female PR-NYC were slightly, but not significantly, higher than those for male and female PR-PR. In contrast, stomach cancer mortality rates for PR-NYC were lower than those for PR-PR throughout the survey period, and mortality decreased substantially in all racial-ethnic groups in New York City and Puerto Rico from 1958 to 1979. Results of this study indicated that the changes in colorectal and stomach cancer incidence and mortality in Puerto Rican-born residents after migration to New York City, although not as dramatic as in migrants from Japan and Eastern Europe, were comparable to those observed for Hispanic migrants to New Mexico and Los Angeles.

Adult↗
PubMed1986

Breast cancer risk in relation to early oral contraceptive use.

It has been suggested that the risk of breast cancer is increased by oral contraceptive use before the first birth, or by use before age 25, particularly if certain formulations are used. These hypotheses were evaluated in a hospital-based case-control study. A total of 521 patients under age 45 with breast cancer were compared with 521 controls matched for age, time of interview, and geographic area. Oral contraceptive use before the first birth was reported by 155 patients and 137 controls. With allowance for confounding by multivariate analysis, the estimated relative risk was 1.0 (95% confidence interval, 0.6-1.5). The estimate was 1.0 (0.2-3.9) for any use among nulliparous women and 0.6 (0.3-1.3) for use before the first birth among parous women. Use before age 25 was reported by 145 patients and 141 controls, and the multivariate relative risk estimate was 1.0 (0.7-1.6); the results were similar when use of specific formulations was examined. For oral contraceptive use before either the first birth or age 25, the relative risk estimates were compatible with 1.0 for use of five or more years' duration or an interval since first use of at least 15 years. There was also no evidence of an increased risk in any subgroup including those at increased underlying risk because of factors such as a family history of breast cancer or a history of cystic breast disease. The findings suggest that, up to age 45, the risk of breast cancer is not influenced by the use of oral contraceptives before the first birth or before age 25 even if the use lasted for five or more years.

Adult↗
PubMed1985

Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens.

In a case-control study of the risk of adenocarcinoma of the endometrium in relation to conjugated-estrogen use, we found that 31 per cent of 425 women with endometrial cancer and 15 per cent of 792 controls reported having used conjugated estrogens; the rate-ratio estimate was 3.5 with a 95 per cent confidence interval of 2.6 to 4.7. For use that lasted at least one year, the rate-ratio estimate for Stage I or II cancer was 5.2 (95 per cent confidence interval, 3.7 to 7.2), and for Stages III and IV combined it was 3.1 (1.5 to 6.4). Among women who had used estrogen for at least one year and then discontinued it, the risk of endometrial cancer remained significantly elevated even after estrogen-free intervals of over 10 years. The findings suggest that long-term use of conjugated estrogen increases the risk of both localized and widespread endometrial cancer. The data also suggest that women who have taken conjugated estrogen for one or more years remain at increased risk for at least 10 years after they discontinue use. Such women should be considered for long-term gynecologic surveillance.

Adenocarcinoma↗
PubMed1985

Cigarette smoking and the risk of endometrial cancer.

Because of evidence of reduced estrogen excretion in the urine of women who smoke cigarettes and evidence linking estrogen levels to the risk of cancer of the female reproductive system, we evaluated the risk of endometrial cancer in relation to cigarette use in a hospital-based case-control study of 510 women with endometrial cancer (cases) and 727 women with other cancers (controls). The rate-ratio estimate (relative risk) for current smokers as compared with women who had never smoked was 0.7 (95 per cent confidence interval, 0.5 to 1.0), and for former smokers the estimate was 0.9 (0.6 to 1.2). For women currently smoking 25 or more cigarettes per day, the rate-ratio estimate was 0.5 (0.3 to 0.8). The effect of current smoking of at least 25 cigarettes per day appeared to be confined to postmenopausal women, among whom the estimate was 0.5 (0.2 to 0.9). Among premenopausal women the estimate was 0.9 (0.4 to 2.2), but the difference between these two estimates could have been due to chance. The data suggest that women who smoke heavily may have a lower risk of endometrial cancer than nonsmokers. The present findings do not have direct public health importance since cigarettes, overall, have serious deleterious effects. However, if these results are confirmed, elucidation of the underlying mechanisms whereby smoking reduces the risk would be of interest and might be useful in the development of strategies for preventing endometrial cancer.

Adult↗
PubMed1985

Breast cancer and the consumption of coffee.

The hypothesis has been raised that coffee consumption may increase the incidence of breast cancer, based on the report that fibrocystic breast disease, a risk factor for breast cancer, regresses after abstention from coffee and other methylxanthines. The relation between recent coffee consumption and the risk of breast cancer was evaluated in a case-control study, based on interviews conducted 1975-1982 at several mainly eastern US teaching and community hospitals. The responses of 2,651 women with newly diagnosed breast cancer were compared with those of 1,501 controls with nonmalignant conditions and 385 controls with cancers at other sites. The relative risk estimates for levels of coffee drinking up to seven or more cups daily, relative to none, approximated 1.0 with narrow 95% confidence intervals. After allowance for confounding, the relative risk estimate for drinking at least five cups a day was 1.2 (95% confidence interval, 0.9-1.6) using the noncancer controls and 1.1 (0.7-1.6) using the cancer controls. Coffee consumption was not associated with an increase in the risk of breast cancer among women with a history of fibrocystic breast disease, nor were tea or decaffeinated coffee associated with an increase in the risk of breast cancer. The results suggest that the recent consumption of coffee does not influence the incidence of breast cancer.

Adult↗
PubMed1979

Alcohol as a co-factor in the etiology of cancer.

Alcohol and tobacco appear to act synergistically in the pathogenesis of epithelial cancers of the oropharynx (excluding lip), larynx, and esophagus. For the subsites within the upper aerodigestive tract, over 10,000 deaths in United States men during 1978 may be attributed to tobacco and alcohol consumption. The cancer sites for which tobacco and alcohol are major determinants occur with greater frequency in men, blacks, lower socioeconomic groups, and with increasing urbanization and increasing age (35--70 years). Because primary hepatocellular carcinoma occurs more commonly in patients with cirrhosis, chronic alcohol abuse is an important risk mechanism for carcinoma of the liver parenchyma. Although experimental animal studies have failed to demonstrate whether ethanol can independently initiate tumorigenesis, various alternative or associated biochemical and immunological mechanisms of action have been proposed.

Adult↗
PubMed1979

Noninvasive breast carcinoma: frequency of unsuspected invasion and implications for treatment.

One hundred twenty-nine biopsies from 121 patients with a frozen or paraffin section diagnosis of noninvasive breast carcinoma were studied. Eight women had bilateral noninvasive carcinoma. Seven biopsies reported as intraductal on frozen section contained invasive carcinoma on paraffin section. Of the remaining 122 biopsies proven to have noninvasive carcinoma on paraffin section, 39 (34%) were reported at frozen section and as noninvasive carcinoma, 24 (20%) as atypical and 59 (48%) as benign. Intraductal carcinoma (IDC) was identified more often at frozen section (45%) than was lobular carcinoma in situ (19%). Among 41 patients who had bilateral carcinoma with invasive disease in one breast, 76% of contralateral noninvasive carcinoma was LCIS. After excisional biopsy, carcinoma was found in 56% of 103 mastectomy specimens, including invasive carcinoma in 6% of breasts with IDC and 4% with LCIS. Residual noninvasive carcinoma was usually of the same type found at biopsy (90% IDC and 88% LCIS) and involved quadrants other than the biopsy site in 33% with IDC and in 80% with LCIS. When the frozen or paraffin section diagnosis of a generous excisional biopsy was noninvasive breast carcinoma, there was a substantial risk that foci of the same type of noninvasive carcinoma were also present in other quadrants. However, occult foci of invasive carcinoma were quite infrequent and the risk of axillary metastases was very low. Adequate treatment for noninvasive carcinoma requires elimination of all residual foci of noninvasive disease. At present this can best be accomplished by total mastectomy if the operation is properly performed. To insure removal of the axillary extension of the breast and for staging, in continuity dissection of the lowest axillary lymph nodes is also prudent.

Axilla↗