[The WE project: mammography significantly decreases breast cancer mortality].
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Adult↗
Biomedical subjects
S W Duffy
Publications and source records attributed to S W Duffy.
Evaluation of an alcohol education package for non-specialist health care and social workers.
A quasi-experimental non-equivalent control group design was used to assess the influence of a two-day experiential alcohol education package for non-specialist health care and social workers. Four pairs of teams took part in the study: general practice; accident and emergency; medicine for the elderly; and social work. The dual foci of the evaluation were agents' knowledge and attitudes, and these were assessed using a modified version of the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ). For both variables, the one-month follow-up scores of the education teams were significantly higher than those of the comparisons, although the effect was stronger in the case of therapeutic attitudes than knowledge. There were also significant differences in improvement in attitude scores, with significant effects being observed in the general practice, medicine for the elderly and social work teams but not the accident and emergency. At 6 months, the level of fall-off in improvement varied and this, along with the pattern of change evident in the five components which comprise the AAPPQ attitude scale, was examined and discussed in relation to previous research in this field of inquiry.
Adult↗
Risk factors for cancer of the buccal and labial mucosa in Kerala, southern India.
STUDY OBJECTIVE: The aim was to investigate risk factors for cancer of the buccal and labial mucosa in Kerala, southern India. DESIGN: The investigation was a case-control study. SETTING: Regional Cancer Centre, Trivandrum, Kerala, and local teaching hospitals. PARTICIPANTS: Cases were all those registered with oral cancers at the Regional Cancer Centre during 1983 and 1984 (n = 414). Controls (n = 895) were selected from admissions to the cancer centre who were found to have non-malignant conditions, or from patients attending outpatients in teaching hospitals of Trivandrum medical college with non-malignant conditions. MEASUREMENTS AND MAIN RESULTS: The risk in males of the following habits was investigated: pan (betel)-tobacco chewing, bidi and cigarette smoking, drinking alcohol, and taking snuff. Only pan-tobacco chewing was investigated in females as very few indulged in other habits. Among males predisposing effects were found for pan-tobacco chewing (p less than 0.001), bidi smoking (p less than 0.001), drinking alcohol (p less than 0.001), and taking snuff (p less than 0.01). As in males, pan-tobacco chewing also had a predisposing effect in females (p less than 0.001). Duration of use was a better predictor of risk than either daily frequency of use or total lifetime exposure, both for pan-tobacco chewing (especially if the habit started before age 21 years) and bidi smoking. However, there were also very high risks associated with the current occasional use of both factors. Pan-tobacco chewing was the most important risk factor, with relative risk of 13.24 with 31-40 years' use, and 37.75 with greater than 40 years' use among males. Corresponding relative risks in females were 21.30 and 54.93. No effect of cigarette smoking was observed (relative risk 0.64, p greater than 0.1). CONCLUSIONS: A substantial majority of cases of buccal and labial cancers are attributable to chewing pan-tobacco. This has obvious implications for instituting preventive measures.
Adult↗
A case-control investigation of cancer of the oral tongue and the floor of the mouth in southern India.
A case-control study of cancer of the oral tongue and floor of mouth was conducted in Kerala, Southern India, on 228 cases and 453 hospital-based controls, matched for age, sex and religion. We studied pan(betel)-tobacco-chewing, bidi (local type of cigarette)-and-cigarette-smoking, alcohol-drinking and snuff use, for their associations with risk, in males. Among females, only pan-tobacco-chewing was analyzed, as very few females indulged in the other habits. In males, a significantly increased risk was observed in association with pan-tobacco-chewing, bidi-smoking, bidi-plus-cigarette-smoking (but not cigarette-smoking alone) and alcohol-drinking (p less than 0.001 in all cases), although the effect of alcohol was no longer significant when adjusted for the other significant predisposing factors. Among females, pan-tobacco-chewing had a similar predisposing effect to that observed in males (p less than 0.001). In males an adjusted relative risk of 6.14 was associated with chewing 10 or more pan-tobacco quids per day (relative to those who never chewed). The corresponding relative risk in females was 9.27. In males, an adjusted relative risk of 7.46 was observed for those smoking 20 or more bidis per day (relative to never-smokers).
Age Factors↗
Colorectal cancer and diet in an Asian population--a case-control study among Singapore Chinese.
A hospital-based case-control study of diet and colorectal cancer was conducted among Chinese in Singapore (who constitute 77% of the population). A total of 203 cases and 425 controls were included. A history of the usual dietary intake one year prior to interview was taken using a quantitative food frequency questionnaire. Daily intakes of nutrients and selected food items were computed and stratified by tertiles of the control range, to assess risk in low-, medium- and high-intake categories. Effects were adjusted in analysis for age, sex, Chinese dialect group and occupation. For cancers of colon and rectum combined, significant observations were a protective effect of high cruciferous vegetable intake (OR = 0.50, p less than 0.01) and a predisposing effect of a high meat/vegetable consumption ratio (OR = 1.77, p less than 0.05). Similar results were observed for colon cancer alone. For rectal cancer alone (only 71 cases), significant (p less than 0.05) protective effects were observed for high intakes of protein (OR = 0.61), fibre (OR = 0.46), beta-carotene (OR = 0.54), cruciferous vegetables (OR = 0.51) and total vegetables (OR = 0.51). When further assessed by multiple logistic regression, tests for trend and assessment of risk in the extreme highest and lowest quintiles of the control range, the factors consistently significant were cruciferous vegetable intake and the meat/vegetable ratio. A particularly high relative risk was also noted in association with low coffee consumption (OR = 1.59, with p less than 0.05 for trend). No consistent trends were noted for fat or fibre intakes. For non-dietary variables investigated, a history of cholecystectomy increased the risk of both cancers combined (OR = 3.43, p less than 0.05) and colon cancer alone (OR = 4.39, p less than 0.01). This study in an Asian population of countries of Southern and Eastern Asia newly undergoing industrialization and in which rapid economic change is reflected in changing cancer patterns, suggests that the protective effects of certain dietary constituents, notably the cruciferous vegetables, may be more important than the hitherto stressed carcinogenic potential of fat and protein.
Age Factors↗
Misclassification in more than one factor in a case-control study: a combination of Mantel-Haenszel and maximum likelihood approaches.
Misclassification can arise in the case-control setting in both the risk factor of interest, and in a potential confounder. If true status is not ascertainable, but an independent replicated sample is available, adjusted maximum likelihood estimates of the individual binomial proportions can be obtained, and hence a relative risk estimate of the Mantel-Haenszel type constructed. An interval estimate on the latter can be calculated using the asymptotic properties of the likelihood function. The method is illustrated by application to a case-control study of breast cancer risk and such lifestyle attributes as diet, smoking and alcohol consumption, in which misclassification was anticipated and consequently repeatability data were collected.
Breast Neoplasms↗
Level of agreement between questionnaire measures of alcohol dependence, alcoholism and problem drinking in a sample presenting at a specialist alcohol treatment service.
Two questionnaire measures of the alcohol dependence syndrome, one of alcoholism, and one of alcohol-related problems were compared in a sample of 101 subjects attending a specialist alcohol treatment unit. There was substantial agreement between the two measures of alcohol dependence, and lesser agreement between any other pairing. The measures of alcohol dependence also showed the strongest correlation with reported weekly alcohol consumption. The findings are compared with previous research, and the suitability of the various questionnaires as case-defining instruments in empirical investigations is discussed.
Adult↗
Tobacco chewing, alcohol and nasal snuff in cancer of the gingiva in Kerala, India.
A case-control study of cancer of the gingiva was carried out in Kerala, Southern India, using 187 cases and 895 hospital-based controls. We investigated the effects on risk in males of pan (betel)-tobacco chewing, bidi and cigarette smoking, drinking alcohol and taking snuff. In females only pan-tobacco chewing was investigated as very few females indulged in the other habits. Among males, significant positive associations with risk were observed for pan-tobacco chewing (P less than 0.001), bidi smoking (P less than 0.001) alcohol drinking (P less than 0.001) and snuff use (P less than 0.05). In females, pan-tobacco chewing had a similar predisposing effect (P less than 0.001). Daily frequency of pan-tobacco chewing was the strongest predictor of risk in males, with a relative risk of 15.07 associated with chewing ten or more quids per day. The corresponding relative risk among females was 13.69. In males a relative risk of 3.20 was associated with smoking more than 20 bidis per day, and relative risks of 2.62 and 3.90 were associated with regular use of alcohol and snuff respectively. Surprisingly high relative risks were observed in association with occasional use of pan-tobacco, bidi, cigarettes, alcohol and snuff. A stepwise logistic regression analysis yielded four predictors: pan-tobacco daily frequency, duration of bidi use, and alcohol and snuff use (regular versus never). There were also significantly elevated risks associated with occasional indulgence in these four habits. Total lifetime exposure was no better at predicting risk than daily frequency or duration of habits.
Adult↗
A method for combining matched and unmatched binary data. Application to randomized, controlled trials of photocoagulation in the treatment of diabetic retinopathy.
A method for combining matched and unmatched data is described and was applied to the results of randomized, controlled trials of photocoagulation in the treatment of diabetic retinopathy. A pooled estimate from the matched and unmatched studies was obtained by adaptation of the Mantel-Haenszel method, where the strata were unmatched studies and matched pairs within studies. A test of significance was based on the Mantel-Haenszel chi-square statistic, the latter also being used to calculate test-based confidence intervals. A test of homogeneity was performed by combining Mantel-Haenszel chi-square statistics from the matched and unmatched studies. By these methods, the combined estimate of the risk of deterioration of visual acuity for those receiving photocoagulation (relative to a risk of unity for those not receiving photocoagulation) was 0.37 (95 per cent confidence interval 0.29-0.46). The chi-square statistic (1 df) for an effect of treatment was 87.75 (p less than 0.0001). The chi-square statistic for homogeneity of relative risk among studies was 11.20 (4 df, p less than 0.05). However, this result was influenced disproportionately by one small matched study.
Diabetic Retinopathy↗
The Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit.
The Swedish two county trial of breast cancer screening is now in its tenth year. This paper presents detailed results on mortality from breast cancer and from all other causes, and on the population denominators at risk for each of the first 8 years of follow up, for each county separately. These data represent a two year update on the last major report. Results show an increasingly significant deficit in deaths from breast cancer among the 77,092 women invited to screening relative to the 56,000 not invited (RR = 0.68, p = 0.002), with no significant difference between the effects of screening in the two counties (p = 0.5). These results remain the same when adjusted for age. Analysis of all cause deaths shows no significant effect of screening (p = 0.5), nor was there any significant effect of screening on deaths from all causes other than breast cancer (p = 0.9). The rates of deaths from intercurrent illness in breast cancer cases were almost identical in the group invited to screening and the group not invited (p = 0.7). This result remained the same when adjusted for age. We calculate that in the age group 50-69 at entry, one breast cancer death was prevented per 4000 woman/years, per 1460 mammographic examinations, per 13.5 biopsies, and per 7.4 breast cancers detected.
Adult↗
Recent trends in cancer incidence among Singapore Chinese.
Since the inception of cancer registration in Singapore in 1968, the incidence rates of malignancies have been monitored among the 3 major ethnic groups--Chinese (77% of population), Malays (15%) and Indians (6%). Substantial changes in incidence at various sites were observed in the period 1968-1982, which seem to represent a shift from the pattern of cancer incidence in China towards that prevailing in the West. We now report on the Singapore Chinese experience, in which the following changes were notable: decreases in rates of cancers of the stomach and oesophagus and increases in rates of cancers of the lung, colon, rectum, skin (excluding melanoma), breast and ovary. For several sites, the secular changes differed among age groups; among women under 50 years of age breast cancer increased particularly sharply and lung cancer decreased. Environmental and personal factors, potentially responsible for the change, are discussed.
Adolescent↗
Risk of breast cancer in relation to reproductive factors in Denmark.
The effect of reproductive factors on breast cancer risk was evaluated in a population-based case-control study, including 1,486 breast cancer cases diagnosed over a one-year period in Denmark. They were identified from the files of the nationwide trial of the Danish Breast Cancer Co-operative group and the Danish Cancer Registry. The control group was an age-stratified random sample of 1,336 women from the general population. Data on risk factors were collected by self-administered (mailed) questionnaires. Significantly increased relative risks (RR) were associated with never being pregnant (RR = 1.47), an early terminated first pregnancy (RR = 1.43), and having a natural menopause after the age of 54 (RR = 1.67). Trends of decreasing risk were observed by increasing parity and age at menarche. These findings were independent of age at first full-term pregnancy which overall was not related to breast cancer risk, though a weak association appeared in women less than 50 years at diagnosis. The study confirmed that pregnancies must continue to term to offer protection against breast cancer.
Abortion, Induced↗
Alcohol consumption by patients attending outpatient clinics.
Three hundred and twenty nine (329) patients aged between 18 and 60 years attending the diabetic, hypertension and fracture clinics were studied with regard to their alcohol consumption. The findings confirm the general view that a considerable number of patients attending the general medical services may be considered as problem drinkers, a factor which may contribute to their overall medical complaint.
Adolescent↗
A survey of household food purchases and dietary habits in relation to affluence among Singapore Chinese.
A survey of 40 Singapore Chinese households was performed, obtaining information on major perishable foods purchased for home consumption in the previous week, extent of home consumption (eating in), household dietary habits and housing type, the last as a measure of affluence. Eating out was very common: nine (23 per cent) households ate less than 50 per cent of meals at home. Excluding these nine households, consumption and habits were compared between more affluent and less affluent households. The more affluent households purchased more red meat/offal (P = 0.001), poultry (P = 0.002), vegetables other than green leafy (P = 0.04), fruit (P = 0.007) and eggs (P = 0.04); they also differed significantly in various dietary habits. Significant differences were also observed between English-speaking and Chinese-speaking households. The results suggest that increasing affluence may have brought about substantial dietary change in Singapore, thus meriting further study of the role of diet in changing disease patterns in Singapore.
Acculturation↗
Screening for breast cancer.
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Breast Neoplasms↗
Detection method, tumour size and node metastases in breast cancers diagnosed during a trial of breast cancer screening.
The relationship between tumour size and lymph node metastases was examined in screening-detected and clinically detected breast cancers. The data used were from a randomized trial of breast cancer screening with mammography. 964 cancers were reviewed, in both arms of the trial, in women aged 40-74. Lymph node status was significantly related to detection method (P less than 0.001), metastases being less common in screening-detected cancers. Node status was also significantly related to tumour size (P less than 0.001), metastases being commoner in larger tumours. Similarly, tumour size was significantly associated with detection method (P less than 0.001), smaller tumours being detected by screening. No significant interaction was observed among all three factors, indicating that the relationship between node status and tumour size did not change with detection method. When detection method was replaced with randomly allocated study (invited to screening) and control (not invited to screening) groups, the same results were observed. It is concluded that if screening detects tumours with a different natural history to that of those which surface clinically, this is not reflected in the relationship between tumour size and lymph node metastases.
Adult↗
Clinical predictors of outcome in encephalitis.
Twenty five patients with encephalitis were studied prospectively, and their clinical and virological features compared with outcome. Among 22 patients with laboratory confirmation of virus infection, evidence of direct effect on the central nervous system by the virus occurred significantly more often both in those with a monophasic illness compared with those with a biphasic illness, and in those with focal neurological signs localising in the cerebral hemispheres compared with those without such signs. Young age at presentation, low score on the Glasgow coma scale, disruption of oculocephalic responses, and laboratory evidence of virus infection within the central nervous system were significantly associated with poor outcome. Computed tomography results, concentrations of creatine phosphokinase BB isoenzyme in cerebrospinal fluid, and procoagulant activity in cerebrospinal fluid were not predictive of outcome.
Adolescent↗