Racial differences in risk of oral and pharyngeal cancer: alcohol, tobacco, and other determinants.

BACKGROUND: In the United States, Blacks have increasingly higher rates of oral and pharyngeal cancer (oral cancer) than Whites, but determinants of the racial disparity have not been clear. PURPOSE: The purpose of this study was to explore reasons for the higher incidence of oral cancer among Blacks than Whites. METHODS: We used data from a large, population-based case-control study of oral cancer risk factors conducted in four areas of the United States. On the basis of interviews that ascertained characteristics of 1065 oral cancer patients (871 Whites and 194 Blacks) and 1182 controls (979 Whites and 203 Blacks), we examined racial differences in exposure prevalences and relative risks for a number of known etiologic factors, including tobacco and alcohol consumption, diet, and socioeconomic and other variables. To evaluate the extent to which the major risk factors explained the excess risk of oral cancer among Blacks, population-attributable risks were calculated. RESULTS: Differences with respect to alcohol consumption, especially among current smokers, emerged as the most important explanatory variables. After adjusting for smoking, heavy drinking (> or = 30 drinks/week) resulted in a 17-fold increased risk among Blacks and a ninefold increase among Whites. Among drinkers, Blacks tended to drink more than Whites. Also, a higher (P = .01) percentage of Blacks (37%) than Whites (28%) were current smokers, although there were little or no racial differences in relative risks or patterns of use for other smoking variables, including number of cigarettes smoked per day, years of smoking, and age started smoking. From population-attributable risk calculations, we estimated that differences in alcohol and tobacco use account for the bulk of the higher incidence of oral cancer among Blacks in the United States and that, in the absence of alcohol and tobacco, the rates of this cancer according to race (Black, White) and gender would be nearly equal. With regard to other potential etiologic factors, protective effects provided by higher dietary intake of fruits and vitamin C were more pronounced for Whites, while Blacks more often tended to be in sociodemographic and medical or dental health categories associated with increased risk. CONCLUSIONS: These analyses provide evidence that various environmental or lifestyle determinants of oral cancer may contribute to the higher oral cancer rates in Blacks than in Whites in the United States, but that patterns and risks associated with alcohol consumption, particularly among current smokers, are the most important contributors to the excess risk in Blacks. IMPLICATIONS: These findings suggest that the key to prevention of oral and pharyngeal cancers among both Blacks and Whites is reduced intake of alcoholic beverages and, because of strong interactive effects, the cessation of smoking.

Measurement of organochlorine levels in postprandial serum or in blood collected in serum separator tubes.

Whether organochlorine blood levels in fasting and postprandial specimens provide equivalent measures of exposure and the extent to which collecting blood in tubes containing material to separate serum and blood cells corrupts the specimen are unclear. In this paper, we present data from two studies that address both of these issues. In the first study, 27 women provided fasting blood in plain, silicone-coated Vacutainer tubes (red-topped) and in similar tubes containing serum separator gel (SSTs), as well as a postprandial specimen in a red-topped tube. The specimens collected in SSTs were left to stand overnight, with the gel in contact with the sample. In the second study, the blood of 12 industrial incinerator workers was collected in red-topped tubes and in SSTs. Blood in SSTs was left in contact with the gel for 5 days. Serum organochlorine residue levels ([1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene] (DDE)) and polychlorinated biphenyls) in samples collected in red-topped tubes were highly correlated with levels measured in samples collected in SSTs (all Pearson r values were > or = 0.79). Postprandial and fasting organochlorine levels were also highly correlated (Pearson r values > or = 0.89). Our results indicate that timing of the collection of blood in relation to meals and use of SSTs to collect blood specimens did not greatly affect the relative classification of subjects with respect to serum level of DDE or polychlorinated biphenyls. The longer the specimen was in contact with the SST gel, however, the lower the level of organochlorine that was detected and, at least for DDE, the greater the misclassification caused.

Chronic polyradiculoneuropathy of infancy. A report of three cases with familial incidence.

Two siblings and a third child exhibited a syndrome of progressive muscular weakness and wasting, closely resembling Werdnig-Hoffmann's disease. Autopsy of one of the siblings and the third child showed nearly total absence of myelin sheaths in the cranial and spinal nerve roots, relative preservation of axons, and normal neurons in the motor cranial nerve nuclei and anterior spinal gray matter. The mother of the siblings had bilateral pes cavus, and the father of the third child had a sensory-motor polyneuropathy dating to childhood, associated with pes cavus and scoliosis. The disorder in these children and in a few similar cases in the literature shares some features of Charcot-Marie-Tooth disease and the hypertrophic neuropathy of Dejerine-Sottas, but it is difficult to classify as either of these familial neuropathies as presently defined. Elevation of cerebrospinal fluid protein is a useful finding in distinguishing such children from patients with Werdnig-Hoffmann's disease.

Are breast implants anticarcinogenic? A 14-year follow-up of the Los Angeles Study.

Despite decades of use, the long-term safety of breast implants in women remains a concern. While the incidence of breast cancer among women has increased dramatically in the past decade, the implant-related risk of carcinoma of the breast only recently has received widespread attention. An additional concern is that the presence of the implant may delay tumor detection. This study allows examination of breast cancer risk and detection issues among patients with long-term exposure. We conducted a record linkage cohort study of cosmetic breast implant patients. We abstracted the records of the private practices of 35 broad-certified plastic surgeons in Los Angeles County, California. We included 3182 white women who received cosmetic breast implants between 1953 and 1980. Spanish-surnamed women, nonresidents of Los Angeles County, and patients with prior subcutaneous mastectomy or breast cancer were excluded. Cancer outcomes through 1991 have been ascertained through record linkage with the Los Angeles County Cancer Surveillance Program. With a median follow-up of 14.4 years, 31 breast cancer cases were observed, compared with 49.2 expected, based on Los Angeles County population-based incidence rates (standardized incidence ratio = 63.0 percent; 95 percent confidence limits: 42.8 and 89.5 percent). The distribution of stage of disease at diagnosis among women with implants did not differ from that of all similar breast cancer patients in Los Angeles County. In Los Angeles County, augmentation mammaplasty patients experience a significantly lower than expected risk of breast cancer and no delay in breast cancer detection after an average of 14.4 years of exposure. While the linkage methodology allows the possibility of failing to detect diagnosed cancer cases and does not permit collection of some pertinent risk factors, the six other published epidemiologic studies on the topic also report breast cancer risk to be at or below the expected rate.

Mandibular growth, condyle position and Fränkel appliance therapy.

A statistical evaluation of condyle position and mandibular length changes in 10 patients after one year of Fränkel appliance therapy, finding the condyle forward on the eminence in 4 of them. Large variations were found in mandibular growth, with no significant difference from the means of patients treated with the Edgewise appliance.

A modified pharyngeal flap operation.

A modification of the standard, superiorly based, pharyngeal flap operation is presented. The results of this procedure are given for 27 patients and they appear to be superior to those reported by the author for the standard operation.

Bilateral hyperplasia of the coronoid process of the mandible. Report of a case.

A case of bilateral hyperplasia of the coronoid process occurred. The diagnosis was made easily, and the treatment was successful. Speculation is made regarding the cause of the condition.

Transpalatal excision of the odontoid process.

A patient with platybasia of the skull and temporomandibular joint ankylosis is presented. Relief of brain stem compression by the impingement of the odontoid through a soft, hypoplastic clivus was done by first doing a mandibular condylectomy to open the mouth. A transoral-transpharyngeal route was then employed to excise the odontoid process.

A comparison of Class II treatment changes noted with the light wire, edgewise, and Fränkel appliances.

The purpose of this study was to determine if selected cephalometric changes noted in groups of growing patients with Class II, Division 1 malocclusions treated with the Fränkel function regulator (FR-2), the edgewise technique, and the light-wire (Begg) mechanism were different and characteristic of a specific technique. To this end, the changes in the SNA, SNB, N-S-Gn, and the SN-GoGn angles, face height (N-M), the anterior movement of pogonion, and the annualized mandibular growth increment (AR-Gn) in a group of patients treated with the FR-2 were compared to the changes noted in similar groups of patients treated by the edgewise technique and the light-wire mechanism. The methods used to compare the groups were an analysis of variance and a discriminant analysis. A reduction in the SNA angle was observed in all groups. It was -0.37 degrees with light wire treatment, -0.60 degrees with Fränkel appliance use, and -1.47 degrees with edgewise therapy. The SNB angle increased in all three groups, ranging from 0.29 degrees in the edgewise group to 0.56 degrees in the Fränkel group. In the light-wire group it was 0.34 degrees. The N-S-Gn angle in the Fränkel group remained essentially the same (0.06 degrees), while in the light-wire and edgewise groups it increased 0.81 degrees and 0.82 degrees. The SN-GoGn angle opened slightly in all groups, ranging from a low of 0.46 degrees with Fränkel therapy to 0.58 degrees with edgewise treatment to 1.25 degrees with the use of the light-wire appliance.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of the parotid gland. Comparison of sialography, non-contrast computed tomography, and CT sialography.

Sialography, non-contrast computed tomography (NCCT), and CT sialography (CTS) were compared in 40 patients with parotid disease. While NCCT and CTS proved to be superior to sialography in most cases, with NCCT being as good as CTS for demonstration of parotid masses, sialography was preferred over both NCCT and CTS for evaluation of inflammatory disease. The role of percutaneous needle aspiration is discussed, and protocols for evaluation of both parotid masses and inflammatory disease are presented.

Medical and dental x rays as risk factors for recently diagnosed tumors of the head.

We used epidemiologic data on 2 tumor sites, the intracranial meninges and the parotid gland, to evaluate the importance of medical and dental x rays as risk factors for radiogenic tumors of the head diagnosed among residents of Los Angeles County in recent years. Exposures to x-ray treatment to the head and to full-mouth dental x-ray series before 1960 appear to be risk factors for both meningiomas and parotid tumors. Evidence from both descriptive and analytic studies suggests that the female over male excess of meningiomas, which is greatest from ages 25 to 54 years, may be partially explained by the excess exposure of young women to dental x rays. Study participants' ability to recall diagnostic x rays accurately is also evaluated by our comparisons of interview data to those available from dental charts. Recall of these events appears to be unbiased and accurate enough to justify the use of interview data in investigations of these risk factors.

[Total protein and immunoglobulin concentrations in the parotid saliva of pregnant women]. / Gesamteiweiss- und Immunglobulinkonzentrationen im Parotissekret Schwangerer.

The content of total protein and immunglobulins in the parotid saliva and blood serum of pregnant women and healthy test persons has been determined by the biuret method and radial immunofiffusion. It was stated that total protein and IgG in the parotid saliva were higher in pregnant women than in healthy test persons, whereas the IgA-levels don't show any differences. IgM was not measurable in the parotid saliva. There was no relationship between saliva and serum immunglobulins. During the pregnancy show the parotid glands another typ of reaction than nonpregnant women.

Respiratory effects of borax dust.

The relation of respiratory symptoms, pulmonary function, and abnormalities of chest radiographs to estimated exposures of borax dust has been investigated in a cross sectional study of 629 actively employed borax workers. Ninety three per cent of the eligible workers participated in the study and exposures ranged from 1.1 mg/m3 to 14.6 mg/m3. Symptoms of acute respiratory irritation such as dryness of the mouth, nose, or throat, dry cough, nose bleeds, sore throat, productive cough, shortness of breath, and chest tightness were related to exposures of 4.0 mg/m3 or more, and were infrequent at exposures of 1.1 mg/m3. Symptoms of persistent respiratory irritation meeting the definition of chronic simple bronchitis were related to exposure among non-smokers. Decrements in the FEV1 as a percentage of predicted were seen among smokers who had heavy cumulative borax exposures (greater than or equal to 80 mg/m3 years) but were not seen among less exposed smokers or among non-smokers. Radiographic abnormalities were uncommon and were not related to dust exposure. Borax dust appears to act as a simple respiratory irritant and perhaps causes small changes in the FEV1 among smokers who are heavily exposed.

Respiratory and eye irritation from boron oxide and boric acid dusts.

Boron oxide has been shown in animals to irritate the respiratory mucosa and conjunctiva. The present study was undertaken to determine whether exposures to boron oxide and its hydration product, boric acid, cause respiratory and eye irritation in humans. One hundred thirteen workers exposed to these materials and 214 unexposed workers were interviewed regarding symptoms. Statistically significant associations were found between eye irritation, dryness of the mouth, nose, or throat, sore throat, and productive cough and mean exposures of 4.1 mg/m3 (which probably did not exceed 8.5 mg/m3).