Breast cancer risk from diet, tobacco, and alcohol.
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Breast Neoplasms↗
Biomedical subjects
S D Stellman
Publications and source records attributed to S D Stellman.
Trends in the first ten years of AIDS in New York City. The New York City Department of Health AIDS Surveillance Team.
With over 37,000 cases of acquired immunodeficiency syndrome (AIDS) reported by the end of 1991, New York City had reported nearly 20% of all US cases in the first decade of the AIDS epidemic. This report examines cases diagnosed through 1990 and reported through 1991 to describe rates and trends in the affected subpopulations. Case data were collected by the New York City Department of Health AIDS Surveillance Team, using a format standardized by the federal Centers for Disease Control. Deaths attributable to human immunodeficiency virus (HIV) infection were examined using data provided by the New York City Department of Health Bureau of Vital Statistics. From 1981 through 1990, 37,436 cases of AIDS were diagnosed: 83% in men over the age of 19 years, 15% in women over 19, 2% in children under 13, and less than 1% in teenagers aged 13-19. Cumulative rates in New York City adults were as high as 100 per 10,000 in nine neighborhoods. Predominant trends included a sustained plateau in reported incidence in men who reported having sex with men and a continuing rise in cases in injection drug users and women infected through heterosexual intercourse. HIV-related deaths in men, women, and children were continuing to rise at the end of the decade. During the first decade of the AIDS/HIV epidemic, case surveillance in New York City measured the visible portion of the epidemic and provided important data on subepidemics.
Acquired Immunodeficiency Syndrome↗
The "over-exposed" control group.
Relative risk is determined as much by the level of exposure among controls as among cases. If cases and controls are drawn from a population in which the range of exposures is narrow, then a study may yield little information about potential health effects. This may be one reason why an association between dietary fat and cancer has not been consistently observed in Western populations. Since the fat intake as a percent of total calories in the US general population varies little, only very large relative risks can be detected in epidemiologic studies. Investigators of the dietary fat hypothesis need to select study groups from populations where the risk factor is not, essentially, narrowly distributed.
Breast Neoplasms↗
A case-control study of multiple myeloma nested in the American Cancer Society prospective study.
Among the subjects enrolled in the American Cancer Society Cancer Prevention Study II, a large nation-wide prospective study, 282 died from multiple myeloma (MM) during the first 4 years of follow-up. These were divided into incident cases who were initially free from disease and prevalent cases who reported MM or related symptoms at the time of enrollment. For each case, 4 controls matched for age, sex, ethnic group and residence were randomly selected. Previous history of diabetes [odds ratio (OR) = 2.0] and employment as farmer (OR = 2.7) were the risk factors consistently suggested by the results of the analysis. The risk associated with farming showed a linear trend with duration of exposure. Pesticide or herbicide exposure was not a risk factor per se but, when combined with farming, it increased the OR to 4.3. Low education, occupational exposure to dyes, and employment in a bank, on the railroad or as a maid were also suggested risk factors, but either they were not statistically significant or they were based on small numbers of exposed subjects. No association between MM and asbestos exposure was observed.
Adult↗
Lung cancer risk is proportional to cigarette tar yield: evidence from a prospective study.
The age-adjusted risk for lung cancer among over 120,000 male current cigarette smokers in the American Cancer Society's 1959-1972 prospective study was analyzed according to tar yield and quantity smoked per day. At each quantity level, the risk increased with increasing tar yield, and at each tar level, the risk increased with numbers of cigarettes smoked daily. The risks in smokers of cigarettes with the lowest yields, however, far exceeded those of former smokers and nonsmokers. The excess lung cancer risk for current smokers was directly proportional to the estimated total milligrams of tar consumed daily: SMR = 100 + 1.731 x milligrams tar per day. Tar yields today are much lower than they were at the time of this study and presage an eventual reduction (but not elimination) of lung cancer risk for those who continue to smoke cigarettes, especially among lifetime smokers of low-tar cigarettes.
Humans↗
The case of the missing eights. An object lesson in data quality assurance.
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Electronic Data Processing↗
Proportions of cancer deaths attributable to cigarette smoking in women.
Over two-thirds of a million American women mostly over age 45 were enrolled in a prospective mortality study in 1982 and followed up for four years. In this time period 1,527 women died of six smoking-related cancer sites: oral cavity, esophagus, pancreas, larynx, lung, and bladder. Age-adjusted death rates in nonsmokers were used to obtain smoking-attributable risks and numbers of deaths due to these six cancers. Among current smokers, 601 deaths (85.5% of current smokers' deaths) were attributable to cigarette smoking, and among former smokers 284 (69.3% of ex-smokers' deaths) were attributable to smoking. Cigarette smoking accounted for 885 excess deaths at these sites, giving a population-attributable risk of 57.9%. Over three-quarters of these excess deaths were due to lung cancer. Cigarette smoking, despite increases in smoking cessation, is still responsible for well over half of the deaths from these six types of cancer in women.
Adult↗
Smoking and lung cancer in women: findings in a prospective study.
Lung cancer rates in relation to smoking habits were studied in a cohort of 619,225 women traced over a 4-yr period (1982 to 1986). A total of 1,006 lung cancer deaths was recorded. The standardized mortality ratio (SMR) for women smokers was 12.7 for current smokers and 4.8 for exsmokers. For those women without a history of chronic diseases, the SMR rose to 17.6 for current smokers. The SMRs rose with the number of cigarettes smoked per day to 22.0 for women who smoked 31 or more per day. SMRs also increased with depth of inhalation; this increase was independent of the number smoked per day. SMRs also increased by duration of smoking and decreased with cessation of smoking. Mortality ratios for lung cancer in women ranged from about 2 to 1 to 3 to 1 in studies carried out in the 1950s and 1960s. As women have begun to smoke earlier in life, smoke more cigarettes a day, and inhale more deeply, we are now observing much higher SMRs in women with lung cancer, similar in magnitude to those seen in men in the earlier studies.
Adult↗
Mortality by relative weight and exercise.
Mortality in relation to relative weight and exercise was analyzed from data collected in the first 2 years of the American Cancer Society's Cancer Prevention Study II. It included data on 868,620 persons who had no history of cancer, heart disease, or stroke and who were not sick at the start of the study. Standardized mortality ratios (SMR) were 187 for men who were 20% or more underweight and 187 for men who were 40% or more overweight. Comparable SMR in women were 186 and 178. Current smokers had considerably higher SMR than nonsmokers for all causes of death and cancer deaths at each relative weight category. Degree of exercise reported by subjects was inversely related to mortality, independent of smoking habits. Subjects who exercised heavily and died of cancer of the lung, colon-rectum, and pancreas had 20% to 37% higher SMR than men and women who reported moderate exercise.
Adult↗
Smoking habits of 800,000 American men and women in relation to their occupations.
The distribution of cigarette smoking (as well as of cigar and pipe smoking in men) by occupation was examined in over 800,000 men and women age 45-70 who were enrolled in the American Cancer Society's prospective study in 1982. Striking variations were seen for men--less striking variations for women. Smoking rates were significantly higher in groups exposed to a number of occupational hazards, compared to groups not so exposed. A considerable amount of variation is related to social class, but some individual occupations exhibit notably high (law enforcement) or low (clergy) smoking rates. This information can be quite useful in planning morbidity or mortality studies of specific occupational groups or in analyzing data from existing studies.
Aged↗
Diesel exhaust exposure and mortality among males in the American Cancer Society prospective study.
In 1982, the American Cancer Society enrolled over 1.2 million American men and women in a prospective mortality study of cancer and other causes in relation to different risk factors. The 2-year mortality of 461,981 males aged 40-79 years with known smoking habit has been analyzed in relation to exposure to diesel exhaust (DE) and to employment in selected occupations related to DE exposure. The relative risk (RR) for all causes of death for those exposed was 1.05 (95% confidence interval [CI]: 0.97-1.13). For lung cancer, the RR was 1.18 (95% CI: 0.97-1.44). A dose-response effect was present. Railroad workers, heavy equipment operators, miners, and truck drivers had a higher mortality both for all causes and for lung cancer when compared with subjects with other occupations and no exposure to DE. Truck drivers exposed to DE were not at excess risk of lung cancer if compared with truck drivers unexposed to DE, but a trend of increasing risk with duration of exposure was suggested. DE exposure was also associated with increase in mortality for accidents, cerebrovascular disease, arteriosclerosis, and cirrhosis of the liver. An association based on small numbers was also present for Hodgkin's disease and lymphoid leukemia. No association with chronic non-neoplastic pulmonary diseases or with bladder cancer was found.
Adult↗
Alcohol and breast cancer: a cohort study.
The relation between alcohol consumption and several causes of death, including breast cancer, was examined in a population of 581, 321 women enrolled in a prospective study in 1959 and followed for 12 years. Women who drank occasionally had about the same breast cancer mortality rate as nondrinkers; those who drank one to four drinks per day had SMRs 7-26% higher; five drinks per day, 1.89; and six or more drinks per day, 1.65. The two highest-consumption groups' risks were significantly higher than those of nondrinkers after multivariate adjustment for several breast cancer risk factors. Distinctive dose-response relationships were observed for two known alcohol-related conditions: cirrhosis of the liver and cancer of the aero-digestive tract, suggesting that results for other causes are not seriously biased by misclassification of drinking habits. Death rates from all causes combined were elevated for drinkers of three or more drinks per day. Whether or not the association of elevated breast cancer death rates ultimately turns out to be causal, there is ample reason to continue to warn the public against excessive drinking.
Adult↗
Combat and herbicide exposures in Vietnam among a sample of American Legionnaires.
A cross-sectional survey of 6810 randomly selected members of The American Legion in six states who served in the U.S. Armed Forces during the Vietnam Era was conducted by a mailed questionnaire. Combat stress was evaluated by a previously validated eight-item scale. Exposure to Agent Orange and other herbicides was estimated via exposure probability index previously developed by the authors which uses an algorithm based on the combined Air Force and Joint Services HERBS files of spray data. Two-fifths of the men had served in Southeast Asia, generally at the same time during which the major proportion of herbicides were used; the remaining subjects served elsewhere. Both combat and Agent Orange exposure exhibited distinct, meaningful distributions among Vietnam veterans with service in Southeast Asia and were also correlated with each other (r = 0.24). Our analysis demonstrates conclusively that mere presence in Vietnam cannot be used as a proxy for exposure to Agent Orange. Categorization of Vietnam veterans according to herbicide exposure can be successfully accomplished, based on an existing detailed herbicide application data base. This analysis, together with the consistent dose-related results obtained in this series of papers on health and behavioral effects, demonstrates the utility of questionnaire-derived herbicide and combat exposure measures for epidemiologic study of Vietnam veterans.
2,4,5-Trichlorophenoxyacetic Acid↗
Social and behavioral consequences of the Vietnam experience among American Legionnaires.
One aspect of a cross-sectional questionnaire study of a sample of Vietnam veterans belonging to The American Legion was devoted to analysis of social and behavioral consequences of service in Southeast Asia. Members of the study population were stratified by whether they served in Southeast Asia and, within the Southeast Asia group, by varying degrees of exposure to combat and to herbicides. Using validated scales for behavioral affect and for the exposure measures for combat and herbicides, a wide range of adverse effects was observed. Men who faced high levels of combat intensity were found to be at greater risk for divorce and for generally being less happy and satisfied with their lives, their marriages, their role as fathers, and as sexual human beings. Although in this population they have reached comparatively high levels of education, they earn significantly less money than peers of their same age and educational attainment. Vietnam veterans returning from combat were found to exhibit higher levels of behavioral disturbances, with mean scores for depression, anxiety, irritation, feelings of helplessness, and physical signs of depression significantly worse than noncombat peers. The lifestyle of combat veterans also continues to place them at greater risk for poor health. They smoke, drink, and use prescription drugs at rates significantly greater than the other veterans in this study. Combat veterans have had a significantly poorer rate of reduction and cessation of smoking and drinking than others in this population. Evidence is also presented which shows that for some of the behavioral outcomes measured, a negative interactive effect of concurrent exposure to herbicides is present.
Combat Disorders↗
Health and reproductive outcomes among American Legionnaires in relation to combat and herbicide exposure in Vietnam.
History of diagnosed illnesses, medical symptoms, and reproductive outcomes and their relation to combat intensity and herbicide exposure were studied, via a mailed questionnaire, among 6810 American Legionnaires who served during the Vietnam War (42% in Southeast Asia, 58% elsewhere). Heart disease, venereal disease, and benign fatty tumors were reported significantly more often by Vietnam veterans than by controls. Combat intensity was significantly dosage-related to history of high blood pressure, ulcers, arthritis and rheumatism, genito-urinary problems, nervous system disease, major injury, hepatitis, and benign fatty tumors. Agent Orange exposure was significantly dosage-related to history of benign fatty tumors, adult acne, skin rash with blisters, and increased sensitivity of eyes to light. Rates of the latter two conditions and of change in skin color were especially elevated in men whose military occupations involved direct handling of herbicides. Five "symptom complex" scales were constructed via factor analysis to measure degrees of feeling faint, fatigue or physical depression, body aches, colds, and skin irritation. Means of all five scales were significantly higher in Vietnam veterans compared to controls, and in herbicide handlers compared to nonhandlers. Both combat and Agent Orange exposure were significant, independent predictors of each of the five scales. Neither combat nor Agent Orange exposure was associated with difficulty in conception, time to conception of first child, or to birthweight or sex ratio of offspring, but maternal smoking was strongly related to reduced birthweight. The percentage of spouses' pregnancies which resulted in miscarriages was significantly higher for Vietnam veterans than controls (7.6% vs 5.5%, P less than 0.001). Logistic regression analysis showed that Agent Orange exposure and maternal smoking were both independently and significantly associated with miscarriage rates in a dose-related manner.
Adult↗
Post-traumatic stress disorder among American Legionnaires in relation to combat experience in Vietnam: associated and contributing factors.
The relationship between combat stress, DSM-III-defined post-traumatic stress disorder (PTSD), and a variety of behavioral factors was examined in a large nonclinical population. A total of 2858 randomly selected American Legion members who had served in Southeast Asia completed a questionnaire which elicited information on military service, personal health, and a variety of mental health outcomes. The data confirm the utility of the PTSD diagnosis as a distinct clinical entity. The frequency of PTSD and the extent of symptoms developed varied with the severity of criteria used for determining the extent of traumatic exposure. The PTSD rate ranged from 1.8 to 15.0% of the total sample, depending on whether "exposure" to combat was defined relatively narrowly or broadly. A distinct linear dose-response relationship between combat stress and a quantitative measure of PTSD intensity was observed. The frequency of PTSD diagnosis was not affected by the presence of either physical or mental health problems which predated military service. A strong, stable relationship was found between combat stress and PTSD intensity for cohorts with differing intervals since the experience of combat trauma, which persisted up to 20 years after discharge from the military. The data thus support a broader approach to defining traumatic events which recognizes individual differences in response to combat, as well as the existence of other behavioral outcomes as residual effects of combat. Implications of these findings and the importance of treating veterans with varying presentations of PTSD are discussed.
Humans↗
Utilization, attitudes, and experiences of Vietnam Era veterans with Veterans Administration health facilities: the American Legion experience.
A random sample of American Legion members in six states who had served in the Armed Forces during the Vietnam Era was conducted through a mailed questionnaire, in order to determine patterns of usage of Veterans Administration health facilities, as well as attitudes toward the VA and experiences at these facilities. Of the 6810 male respondents, 42.0% had served in Southeast Asia. These subjects were categorized according to their level of combat in South Vietnam. Thirty-six percent of those who had served in Southeast Asia had used VA health facilities, compared to only 18% of men who served elsewhere. Among Southeast Asia veterans, combat level was an important predictor of extent of usage of VA facilities for problems of both physical and mental health. Combat level was also associated with lack of basic and major medical insurance. While men with lower incomes tended to make greater use of VA mental health facilities, nearly one-fourth of mental health users had family incomes above $30,000. Despite their greater usage of the VA, men with higher combat levels expressed lower feelings of security about this agency, and rated its staff less helpful and of lower quality than did men who experienced lower levels of combat. On the other hand, higher combat veterans thought themselves better informed about VA services. Men who had gone to the VA for mental health assistance reported a disturbingly low frequency of having been asked basic questions that relate to possible diagnosis of post-traumatic stress disorder (PTSD), questions related to combat, which may be one of its etiologic factors, or other questions relating to their military history. Because combat level in Vietnam veterans is a major determinant of both attitudes toward and utilization of VA health facilities, the VA as well as other health agencies which deal with Vietnam veterans should be especially sensitive to this factor, and should take it into consideration when evaluating veterans' physical and mental health.
Attitude↗
Patterns of artificial sweetener use and weight change in an American Cancer Society prospective study.
Extreme obesity and leanness are risk factors for many types of cancer. An earlier American Cancer Society study (1959-1972) found a nearly twofold increased risk for death from all causes in men and women who weighed 40% or more above average for their age and height, and found elevated cancer rates as well. A new (1982), ongoing ACS prospective study of 1.2 million men and women continues to find increased death rates from all causes and from cancer in the very heavy and the very lean. Artificial sweetener (AS) use is an important correlate of relative weight in this population. The relationship between weight change during the year preceding enrollment and AS usage was studied in a highly homogeneous subgroup of 78694 women ages 50-69 years. The percentage of users increased with body mass index (BMI) and was inversely related to age. Users were significantly more likely than non-users to gain weight, regardless of initial BMI. Among those who gained weight, the average number of lbs gained by AS users was higher (by 0.5-1.5 lb) than the amount gained by non-users. Within the entire cohort, AS users of both sexes ate chicken, fish and vegetables significantly more often than did non-users and consumed beef, butter, white bread, potatoes, ice cream and chocolate significantly less often, suggesting that our weight change results are not explicable by differences in food consumption patterns.
Aged↗