Mammography in Atlanta.
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Breast Neoplasms↗
Biomedical subjects
J M Liff
Publications and source records attributed to J M Liff.
Decline in the incidence of carcinoma in situ of the cervix.
Temporal trends in the incidence of carcinoma in situ of the uterine cervix were evaluated in metropolitan Atlanta between 1975 and 1983. The average annual age-adjusted incidence rates per 100,000 women decreased from 61.5 in 1975-77 to 40.1 in 1981-83 for Whites and from 118.3 to 51.8 for Blacks during the same time periods. The relative declines were uniform across all age groups and exceeded the corresponding reductions in the incidence of invasive cervical carcinoma.
Adolescent↗
Exercise as a risk factor for infertility with ovulatory dysfunction.
To examine the relation of regular vigorous exercise to ovulatory infertility, we interviewed 346 infertile women, in whom there was evidence of ovulatory failure, regarding their exercise patterns during the year preceding their unsuccessful effort to conceive. Their responses were compared with similar exercise histories in women who had successfully conceived at the time the infertile women started trying to become pregnant. Vigorous exercise for an hour or more per day was reported more commonly in nulligravid cases (n = 187) than by their primiparous controls. The difference was particularly great in the subgroup of cases without additional evidence of tubal dysfunction (relative risk = 6.2, 90% confidence interval = 1.0 - 39.8). This association was not seen among infertile women who had previously been pregnant. Vigorous exercise for an average of less than one hour per day was not associated with either primary or secondary infertility.
Adult↗
Mortality in women following hip fracture.
The mortality of white female residents of King County (WA) 50-74 yr of age who sustained an isolated fracture of the hip (n = 168) or lower forearm (n = 217) during 1976-79 was monitored during the 2 yr following the fracture. Among the women with hip fracture the (age-adjusted) percentages who died by the end of the first and second year were 5.9 and 10.5%, respectively. Among women with forearm fractures, the corresponding 1- and 2-yr percentages were 1.9 and 2.7%, values similar to that of white women of comparable ages in the population as a whole. The fact that women who broke their hip experienced a higher mortality rate than those who broke their forearm, while women in both groups were similar in having experienced trauma that led to a fracture, argues that it is the hip fracture and its consequences that lead to an increased death rate, rather than the factors that predispose to a fracture.
Aged↗
Accounting for the multicausal nature of disease in the design and analysis of epidemiologic studies.
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Disease↗
Events of reproductive life and the incidence of epithelial ovarian cancer.
Women resident in six counties of Washington and Utah for whom diagnoses of epithelial ovarian cancer were made during 1975-1979 were interviewed concerning their menstrual, reproductive and medical histories. For comparison, interviews were also obtained from a random sample of women living in the same countries. Logistic regression methods were used, and histories of childbearing, miscarriages, lactation, and (in Washington) usage of oral contraceptives were found to be associated with decreased risk of ovarian cancer; the estimated relative risks were, respectively, 0.88 per pregnancy (i.e., 0.88(2) for two pregnancies, etc.) (p = 0.016), 0.82 per miscarriage (p = 0.049), 0.79 per year of lactation (p = 0.034), and 0.89 per year of oral contraception (p = 0.009). In addition, it was observed that the magnitudes of the diminished risks from these exposures substantially exceeded those which would have been expected solely on the basis of their inhibition of ovulation (X2(5) = 21.5, p = 0.0006). On the other hand, the lack of association found between the occurrence of ovarian cancer and either total dose or total time of exposure to noncontraceptive estrogens, or with a history of usage of thyroid medications, suggests that periods of reduced pituitary gonadotrophin secretion fail to reduce risk of ovarian cancer. Thus, although pregnancy, lactation and oral contraception appear to offer some protection against the development of epithelial ovarian cancer, the reasons remain obscure.
Adult↗
Cutaneous melanoma in relation to exogenous hormones and reproductive factors.
Eighty-seven women of ages 37-74, who resided in King County, Wash., and who had been diagnosed between July 1976 and November 1979 as having cutaneous malignant melanoma, were interviewed regarding prior use of estrogen-containing preparations and reproductive history. The responses were compared with those of a random sample of 863 women from the same county. Among the 61 women with superficial spreading melanoma (SSM), use of oral contraceptives for 5 years or more was more common than among controls. The estimated relative risks for users of 5-9 and 10 years or more were 2.4 and 3.6, respectively. No differences between cases and controls were noted for oral contraceptive use of 4 years or less. Giving birth to a first child after age 30 was also associated with an increased relative risk of SSM. Although the positive findings regarding oral contraceptive use and age at birth of first child must be interpreted cautiously pending results of other studies, they suggest that hormonal factors can play a role in the etiology of SSM.
Adult↗
Noncontraceptive estrogen use and the occurrence of ovarian cancer.
Female residents of six counties in Washington and Utah in whom ovarian cancer was diagnosed during 1975-79 were interviewed concerning prior use of noncontraceptive estrogens. Interviews with a random sample of women drawn from these counties were obtained for comparison. Taken as a whole, women with epithelial ovarian tumors reported estrogen use for 1 year or more somewhat more often than did controls [relative risk (RR) = 1.3, 95% confidence interval (CL) = 0.9-1.8]. The proportion of women who had used estrogens varied according to the histology of their tumor; notably, of 17 women with endometrioid tumors, 12 had used estrogens (RR = 3.1, 95% CL = 1.0-9.8). The excess risk of endometrioid carcinoma related to estrogen use was not further increased when these hormones were taken for long durations, in high doses, or proximate to the time of diagnosis. Neither was there any evidence of increased risk from estrogen use in the small group of women with clear cell tumors, a histologic tumor type believed to be closely related to endometrioid carcinoma. Thus the observed association between menopausal estrogen use and the occurrence of ovarian endometrioid tumors should be interpreted cautiously until the results of additional studies are available.
Adenocarcinoma↗
Incidence of ovarian cancer in relation to the use of oral contraceptives.
Female residents of six counties in Washington and Utah in whom a diagnosis of ovarian cancer was made during 1975-79 were interviewed concerning prior use of oral contraceptives. Interviews with a random sample of women drawn from these same counties were obtained for comparison. A smaller proportion of women with epithelial ovarian tumors had taken oral contraceptives than had controls: the estimated risk of ovarian cancer in uses relative to that in non-users was 0.57 (p = 0.04). The magnitude of the decreased risk depended on the duration over which oral contraceptives had been taken, as the negative association was present only after 4 or more years of use. In many ways, the use of oral contraceptives mimics the physiologic effects of pregnancy. The results of the present investigation, when interpreted together with those from other epidemiologic studies and from experiments in animals, suggest that, like pregnancy, the use of oral contraceptives has a protective effect against the development of ovarian cancer.
Adult↗
Cancer screening intervention among black women in inner-city Atlanta--design of a study.
This experimental study attempts to determine if an in-home educational intervention conducted by lay health workers (LHWs) can increase adherence among low-income, inner-city black women to schedules for screening for breast cancer and cervical cancer, as well as increase the women's knowledge and change their attitudes regarding these cancers. This paper is a description of the purposes, hypotheses, design, subject recruitment, intervention, and evaluation of the study conducted by Morehouse School of Medicine. Subjects were recruited from a variety of sources, including patients seen in a community health center, women referred by the National Black Women's Health Project (NBWHP), residents of public and senior citizen housing projects, and persons identified in various community settings. Fewer than half of those asked to participate agreed to do so. The 321 women who were recruited were demographically diverse. Overall, about half of these volunteer subjects self-reported at least one Papanicolaou (Pap) smear and one breast examination within a year before enrollment in the study. There was little variation by source of recruitment in compliance with screening recommendations, except that referrals from NBWHP were more likely (P less than 0.01) to have had a Pap test and breast self-examination, while residents of public housing projects were somewhat less likely to have done so. About 35 percent of participants ages 35 and older had a mammogram within an appropriate interval. Participants were randomly assigned to intervention and control groups. Women in the intervention group were visited in their homes by LHWs on three occasions; the LHWs provided education on cancer and reproductive health. The groups were comparable in their baseline sociodemographic status and previous screening history.
Adolescent↗
Recent trends in the epidemiology of cervical neoplasia.
Incidence and survival rates were estimated for all white and black women in metropolitan Atlanta with a new diagnosis of in situ or invasive cervical carcinoma between 1975 and 1986. During this period, the average annual age-adjusted incidence (per 100,000) of in situ lesions declined from 51.4 to 25.6 among whites and from 102.2 to 34.6 among blacks. The average annual age-adjusted incidence rate of invasive cervical cancer decreased from 11.8 to 8.2 for whites and from 33.0 to 26.7 for blacks. Although the black-to-white ratio of carcinoma in situ incidence rates declined progressively over time, the excess of invasive cancer among blacks did not decrease. The five-year cumulative survival percentages by stage for whites and blacks, respectively, were 99.1 and 99.1 for in situ carcinoma, 92.2 and 80.5 for locally invasive carcinoma, 49.2 and 40.5 for regionally invasive carcinoma and 3.1 and 3.4 for cases with distant metastases. No improvements in stage at diagnosis of invasive cancer or stage-specific survival rates were observed during this period.
Age Factors↗
The use of interviews with surrogate respondents in a case-control study of oral cancer.
The purpose of this study was to assess the possible bias that may occur in case-control studies when exposure information is not collected from all potentially eligible cases. The data used in this study were collected in the metropolitan area of Atlanta as part of a multicenter, population-based, case-control study of oropharyngeal cancer. In-person interviews were conducted with 112 cases (67.9 percent) and information on an additional 23 ill or deceased cases (13.9 percent) was collected through surrogate respondents. The cases about whom information was collected from surrogate respondents had more advanced disease at the time of diagnosis and were more likely to be black and less educated than cases who were interviewed in person. Cigarette smoking and consumption of hard liquor were more common among the cases about whom information was collected through surrogates. Therefore, failure to include such information would have resulted in underestimates of the strength of association between these exposures and the risk of oropharyngeal cancer.
Adult↗
Effect of a cancer screening intervention conducted by lay health workers among inner-city women.
INTRODUCTION: We conducted a randomized controlled trial to determine if an in-home educational intervention conducted by lay health workers (LHWs) could increase adherence among low-income, inner-city, African-American women to breast and cervical cancer screening schedules. METHODS: We recruited 321 African-American women from diverse inner-city sources. After baseline interviews, they were randomly assigned to either the intervention (n = 163) or the control (n = 158) group. Those in the intervention group were visited in their homes up to three times by LHWs who provided a culturally sensitive educational program that emphasized the need for screening. RESULTS: Ninety-three (93) women in the intervention group and 102 in the control group completed the postintervention interview. For Pap smears, the increase in screening was similar in both groups. For clinical breast exams (CBEs), however, there was a modest increase in the intervention group. The improvement was greatest for mammography, for which there was a 10% to 12% increase. Among women who were not on recommended schedules at baseline, the improvement was substantial and greater in the intervention group. CONCLUSIONS: LHWs' intervention appeared to improve the rate at which inner-city women obtained CBEs and mammograms, but had no effect on Pap smears. A high attrition rate weakened our ability to make conclusive statements about the exact impact of the intervention.
Adolescent↗