An epidemiologic case-control study of breast cancer and exposure to hair dyes.

An epidemiologic case-control study of 1617 patients with a primary breast cancer and 1617 control subjects was conducted to test the hypothesis that use of hair dyes is related to breast cancer. No overall association was observed between breast cancer risk and "ever use" of hair dyes (odds ratio, 1.04; 95% confidence interval, 0.90 to 1.21), age when hair dye use started and age when it stopped, duration of hair dye use (years), types of hair dyes used, and estimated lifetime number of individual applications. The current data set also failed to show an increased risk for breast cancer in women who had been diagnosed with benign breast disease and were exposed to hair dyes.

Cigarette smoking and breast cancer.

An epidemiological case-control study was conducted in New York State, with 1617 primary breast cancer patients and an equal number of controls, to examine the relationship between cigarette smoking and breast cancer. Results showed no overall association between ever smokers versus never smokers and breast cancer risk (odds ratio [OR] = 1.03, 95% confidence interval [CI]: 0.90-1.19), nor was there any dose response trend observed with increased levels of smoking. In addition, no association was found with risk and age started smoking, age stopped smoking, amount smoked or total years smoked. Controlling for previously identified risk factors for breast cancer in the analysis did not significantly alter these relationships. Previous studies have found a difference in menopausal age among smokers compared to nonsmokers. The mean menopausal age was only slightly lower in smokers than in never smokers for both cases and controls. Breast cancer risk was observed to be close to unity for premenopausal women (OR = 0.97, 95% CI: 0.74-1.34) and postmenopausal women (OR = 1.06, 95% CI: 0.91-1.26). A recent study suggested breast cancer risk was more strongly related to starting smoking at a young age among women who smoked at least 25 or more cigarettes per day in the most recent year of smoking. This hypothesis was not supported by these data.

Cholesterol and cancer in a population of male civil service workers.

Cancer incidence and mortality were ascertained in a cohort of 1910 male participants of the Albany Cardiovascular Health Center (CVHC). The New York State Cancer Registry, vital records files, CVHC follow-up records, New York State Retirement System files, and New York State Department of Motor Vehicles driver's license files were used. Serum cholesterol measurements as well as values for other exposure variables were obtained from records of medical examinations which began in 1953-1954. The study cohort was divided into two groups, based on initial serum cholesterol measurement (less than or equal to 190 mg/100 ml and less than or equal to 190 mg/100 ml). For total cancers, both incidence and mortality were similar in these groups. For digestive cancer, both incidence and mortality were slightly lower in the less than or equal to 190 mg/100 ml group. The deficit was not statistically significant. For respiratory cancer, relative risk and rate ratio estimates were in the range of 1.4-1.7 for incidence and mortality. The excess risk in the less than or equal to 190 mg/100 ml group was of borderline statistical significance. The association was concentrated in the lowest cholesterol quintile rather than suggesting a strong dose-response relationship. The estimates were not found to be confounded by cigarette smoking, body mass index, education or age. A reduction in the crude rate ratio estimate from 1.5 to 1.2 was observed when early cases were excluded, suggesting that part of the observed excess may be due to preclinical cancer.

An epidemiological case-control study of breast cancer and alcohol consumption.

A case-control study of breast cancer and alcohol consumption was conducted with 1617 patients diagnosed with a primary cancer of the breast between 1982 and 1984 in 18 New York State counties. For each case, one control, matched for year of birth and county of residence, was selected from the driver's license files of the New York State Department of Motor Vehicles. Breast cancer risk was shown to increase as daily consumption of alcohol increased, with a risk of 1.37 (95% Cl = 1.07, 1.75) observed among women who consumed 15 or more grams of alcohol per day. Breast cancer risk did not appear to be related to the total number of years a woman drank or to be restricted to specific types of alcoholic beverages. The data suggest that this may be higher in women who began drinking at a later age. The increased risk associated with alcohol consumption, observed in the current study, persisted within strata of various breast cancer risk factors.

Case-control study of cancer of the vulva.

A case-control study of 209 vulvar cancer patients and 348 community controls allowed assessment of risk factors for this rare tumor. As with cervical cancer, risk increased with the number of reported lifetime sexual partners, with five or more partners associated with two- to threefold increases in risk compared with zero to one partner. This factor largely explained the associations of risk with early age at first intercourse and low socioeconomic status. An independent association, however, was noted between vulvar cancer and a history of genital warts (relative risk 15.2; 95% confidence interval 5.5-42.1). Women who reported a previous abnormal Papanicolaou smear were at excess risk (relative risk 1.8), as were current smokers (relative risk 2.0). A significant interaction was noted between smoking and genital warts, with women reporting both having 35 times the risk of those with neither factor. Menstrual, reproductive, and hygiene factors were generally unrelated to risk. The relationships with sexual factors and genital warts support a common etiology for cervical and vulvar cancers. Future studies should focus on the etiologic agents for genital warts--the human papillomaviruses--and their enhancement by other factors, especially smoking and/or immune deficiencies.

The epidemiology of burn injury in New York.

A population-based study of all patients hospitalized for burns in a 2-year period was conducted in up-state New York. The objective was to provide data for setting burn injury prevention priorities and for formulating treatment facility plans. The incidence rate of hospitalization for burns was 27 per 100,000 population per year. The mean estimated size of the burn wounds was 9 percent of the body surface, and fewer than 10 percent of the patients had large wounds (more than 20 percent of the body). Burn patients were admitted to hospitals of all capabilities, including 89 percent of 223 hospitals. Substantial numbers of patients with large and deep wounds were treated in hospitals with little burn treatment experience. High-risk groups were the young, blacks, and males. Burn injuries occurring at work were common. Burn injuries resulting in hospitalization occurred less frequently, and the wounds were smaller in size than would have been expected based on reports in the literature.

Cancer control planning and establishment of priorities for intervention by a state health department.

A number of data sources routinely available to State health departments were analyzed as part of a State health department cancer control planning effort. This planning effort consisted of seven steps; the most challenging one was the establishment of priorities for cancer control interventions. Using data from available sources, however, a framework for prioritizing potential cancer control interventions as well as choosing a geographic area in which to implement selected interventions was developed. Factors considered in this framework for setting intervention priorities included the magnitude of the problem; the existence of scientific consensus regarding the efficacy of intervention techniques; the availability of data needed to plan, implement, and evaluate an intervention; the availability of resources within communities to implement an intervention; and the existence of public demand for the intervention. The development and use of this cancer control planning model and framework for setting cancer control intervention priorities in New York State are described in this paper. In using this planning model and framework for setting priorities, quantitative elements were found to be most necessary to define problems, but qualitative elements were most crucial for decision making.

Birth weight, maternal weight and childhood leukaemia.

There is mounting evidence that childhood leukaemia is associated with high birth weight, but few studies have examined the relationship between leukaemia and other perinatal factors that influence birth weight, such as maternal weight or gestational weight gain. This case-cohort study included 916 acute lymphocytic leukaemia (ALL) and 154 acute myeloid leukaemia (AML) cases diagnosed prior to age 10 years between 1985 and 2001 and born in New York State excluding New York City between 1978 and 2001. Controls (n=9686) were selected from the birth cohorts for the same years. Moderate increased risk of both ALL and AML was associated with birth weight 3500 g or more. For ALL, however, there was evidence of effect modification with birth weight and maternal prepregnancy weight. High birth weight was associated with ALL only when the mother was not overweight while heavier maternal weight was associated with ALL only when the infant was not high birth weight. Increased pregnancy-related weight gain was associated with ALL. For AML, birth weight under 3000 g and higher prepregnancy weight were both associated with increased risk. These findings suggest childhood leukaemia may be related to factors influencing abnormal fetal growth patterns.

Preventing tap water burns.

Based on a 1974-1975 survey of hospital records in upstate New York, we estimate that 347 tap water burns will require inpatient treatment annually, with children and the elderly at increased risk. The number and severity of burns from tap water makes them an important prevention priority. Reducing the temperature of household hot water supplies could be a practical and effective prevention measure.

Parental occupational exposures and risk of neuroblastoma: a case-control study (United States).

BACKGROUND: A case-control study was conducted with 183 histologically confirmed neuroblastoma cases aged 0-14 years diagnosed among residents of New York State, excluding New York City, between 1976 and 1987. Three hundred seventy-two controls were selected from the New York State live birth certificate registry and were matched to cases on year of birth. METHODS: Parental occupational exposures at the time of each child's birth were obtained from maternal telephone interviews, successfully completed for 85% of cases and 87% of controls. RESULTS: Odds ratios were significantly elevated for maternal occupation in the service (OR = 2.0, 95% CI = 1.0 4.1) and retail (OR = 2.0, 95% CI = 1.1-3.7) industries and paternal occupation in materials handling (OR = 3.8, 95% CI = 1.1-14.6). Odds ratios were also significantly elevated for maternal report of occupational exposure to acetone (OR = 3.1, 95% CI = 1.7-5.6), insecticides (OR = 2.3, 95% CI = 1.4-3.7), lead (OR = 4.7, 95% CI = 1.3-18.2) and petroleum (OR = 3.0, 95% CI = 1.5-6.1) and paternal exposure to creosote (OR = 2.1, 95% CI = 1.1-4.3), dioxin (OR = 6.9, 95% CI = 1.3-68.4), lead (OR = 2.4, 95% CI = 1.2-4.8), and petroleum (OR = 1.8, 95% CI = 1.1-2.8). CONCLUSIONS: Due to the uncertainty of the biologic plausibility of these associations and the possibility of alternative explanations, these results should be interpreted cautiously.

Gravid health status, medication use, and risk of neuroblastoma.

The epidemiology of neuroblastoma suggests that prenatal exposures may be important etiologic factors in this disease. The authors describe the role of maternal health status and prenatal medication usage and risk of neuroblastoma. This retrospective study was based on completed interviews with 183 histologically confirmed neuroblastoma cases aged 0-14 years diagnosed among residents of New York State (excluding New York City) between 1976 and 1987. Controls were matched to cases on year of birth and race and were drawn from the New York State live birth certificate registry. Interviews were satisfactorily completed with 85% of the cases and 87% of controls. Significantly elevated odds ratios were noted for vaginal infections during pregnancy (odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.2-4.0), medical treatments for vaginal infection during pregnancy (OR = 2.4, 95% CI 1.2-4.9), and any reported use of sex hormones during pregnancy (OR = 3.0, 95% CI 1.3-6.9). Point estimates for any hormone use suggested elevated risk among male offspring (OR = 4.4, 95% CI 1.5-13.3). Among the individual exposures comprising any hormone use, only hormone use related to infertility was observed to be significant (OR = 10.4, 95% CI 1.2-89.9). A protective effect was noted for self-reported vitamin use (OR = 0.28, 95% CI 0.03-0.69). Although it is not possible to presume a specific role for prenatal hormone exposure as initiator or promoter, these findings lend support to an association between prenatal hormone exposure and risk of neuroblastoma.

Alcohol consumption and breast cancer: estrogen receptor status and histology.

Data from a case-control study conducted in New York State during 1982-1984 were used to evaluate the relation between alcohol consumption and estrogen receptor-positive and estrogen receptor-negative breast cancers and alcohol and various histologic subtypes. The cases were women between 20 and 79 years of age with a diagnosis of primary breast cancer. A total of 794 estrogen receptor-positive and 358 estrogen receptor-negative breast cancer cases were available for study. Controls (n = 1,617) were selected from driver's license files of the New York State Department of Motor Vehicles. Information on estrogen receptor status and histology was obtained from hospital records. The risk of estrogen receptor-positive breast cancer was shown to increase with increasing amounts of alcohol consumption in grams per day (odds ratio (OR) = 1.18 (95% confidence interval (CI) 0.88-1.57) for < 1.5 g/day, 1.28 (95% CI 0.91-1.80) for 1.5-4.9 g/day, 1.28 (95% CI 0.96-1.70) for 5.0-14.9 g/day, and 1.35 (95% CI 0.99-1.85) for > or = 15.0 g/day). There was no relation between alcohol consumption and estrogen receptor-negative tumors (OR = 0.92 (95% CI 0.62-1.36) for < 1.5 g/day, 1.19 (95% CI 0.77-1.83) for 1.5-4.9 g/day, 0.94 (95% CI 0.64-1.35) for 5.0-14.9 g/day, and 1.05 (95% CI 0.70-1.59) for > or = 15.0 g/day). The risk for each of the histologic subtypes studied increased with increasing daily alcohol consumption. These findings suggest that alcohol may only increase a woman's risk of estrogen receptor-positive breast cancers.

Cancer incidence trends in women at high risk of human immunodeficiency virus (HIV) infection.

To determine the types and rates of tumors which may be associated with HIV infection in women, we used cancer incidence data from New York and northern New Jersey. We examined changes in incidence of selected cancers in women aged 20-49 years and compared groups differing in incidence of AIDS. Black women were compared to white women in New York City and in the remainder of New York State; for cervical cancer, rates were also compared for Blacks and Whites in northern New Jersey. The incidence of Kaposi's sarcoma in women increased in New York City, beginning in 1982 for Blacks and in 1984 for Whites, but remained stable in the remainder of New York State. The incidence of non-Hodgkin's lymphoma in New York women doubled in Blacks after 1982 whereas incidence trends in Whites were unchanged. No consistent variation was seen in the incidence of Hodgkin's disease. Cervical cancer in New York and northern New Jersey Blacks declined over the same period by approximately 40% for invasive tumors and 50% for in situ lesions. The HIV epidemic is associated with substantial excesses of Kaposi's sarcoma and non-Hodgkin's lymphoma in women. The absence of Kaposi's sarcoma in upstate New York women suggests the existence of a geographically restricted co-factor(s) for Kaposi's sarcoma in addition to HIV. If HIV affected cervical cancer incidence through 1988, its impact was small compared to the striking decreases which followed widespread adoption of Papanicolaou screening.

Development of cancer prevention and control initiatives in a state health agency: the New York experience.

The public health response to cancer in the New York State Department of Health has evolved over many years. A number of organizational units contribute to surveillance and monitoring, quality assurance, policy analysis and advocacy, education, service delivery, and evaluation components. Extensive cooperation with health professionals and consumers outside of state government is also essential.

Hospital volume differences and five-year survival from breast cancer.

OBJECTIVES: The purpose of this study was to determine the effect of hospital volume on long-term survival for women with breast cancer. METHODS: Survival analysis and proportional-hazard modeling were used to assess 5-year survival and risk of death, adjusting for clinical and sociodemographic variables. RESULTS: At 5 years, patients from very low-volume hospitals had a 60% greater risk of all-cause mortality than patients from high-volume hospitals. CONCLUSIONS: Hospital volume of breast cancer surgical cases has a strong positive effect on 5-year survival. Research is needed to identify whether processes of care, especially postsurgical adjuvant treatments, contribute to survival differences.

Perinatal factors and risk of neuroblastoma.

Neuroblastoma is a malignancy commonly diagnosed during infancy or early childhood, raising speculation about the role of perinatal factors and risk of disease. Using a case-control design, cases included 155 infants and children aged 0-5 years with histologically confirmed neuroblastoma diagnosed and reported to the New York State Cancer Registry between 1976 and 1987. Controls were randomly selected from the State's Livebirth Registry and were frequency matched to cases on year of birth (n = 310). Medical records of cases were used to verify histology and stage of disease. Data on perinatal factors were ascertained from birth certificates and standardised telephone interviews with mothers. Unconditional logistic regression was used to estimate (un)adjusted odds ratios (OR) and 95% confidence intervals (CI). Both preterm (< 37 weeks) and post-term (> 42 weeks) birth were associated with a reduction in risk (OR = 0.4 [CI = 0.1, 0.9] and OR = 0.3 [CI = 0.1, 0.7] respectively) after controlling for confounders in unconditional logistic regression analysis. Elevated risk factors included: smoking during pregnancy (OR = 1.6; CI = 0.9, 2.8), contracted pelvis (OR = 2.3; CI = 0.6, 9.8), birth injury (OR = 2.9; CI = 0.3, 24.9) and 1-min Apgar Score < or =3 (OR = 6.0; CI = 0.9, 38.6); all confidence intervals included one. These data suggest that extremes in gestation may be associated with a reduced risk, although aetiological mechanisms remain unknown.

An epidemiologic case-control study of central nervous system tumors in children and parental occupational exposures.

A population-based case-control study was conducted with 338 patients less than 15 years of age who were diagnosed with a primary tumor of the central nervous system from January 1968 through December 1977 in 53 contiguous New York counties. The study also included 676 controls who were selected from the birth certificate files of the New York State Department of Health. Parental occupational exposures at the time of each child's birth and at the time of tumor diagnosis were derived from maternal interviews. The current data set failed to show any consistent association between childhood central nervous system tumor risk and paternal occupational exposures to hydrocarbons or to electromagnetic fields, or employment in the aerospace industry or pulp and paper manufacturing. Findings for occupational exposures to ionizing radiation were also inconsistent. A positive association was observed between central nervous system tumor risk and paternal exposures to ionizing radiation based on industrial codes. Odds ratios ranged from 1.71 to 2.15. This association was not observed when paternal occupational titles were used to define exposure (range of odds ratios, 1.01-1.10). Maternal exposures to ionizing radiation were not related to risk regardless of the classification scheme used.

Factors associated with repeat mammography in a New York State public health screening program.

Screening mammography is the most effective method for early detection of breast cancer, but repeat mammography rates are not optimal in most populations. Since 1988, New York State has supported a program of breast cancer screening for underserved, uninsured, or underinsured women. The present study was designed to identify sociodemographic and clinical factors associated with failure to return for repeat mammography screening after a negative initial mammogram. Of women initially screened between 1988 and 1991 (N = 9,485), 27 percent obtained repeat mammograms by 1993. The final logistic regression model contained program site, race and ethnicity, family income, and time since last mammogram.

Health effects associated with exposure to radioactively contaminated gold rings.

This study was designed to assess the health risks associated with exposure to radioactively contaminated gold rings. A group of 135 exposed individuals, who were identified through a statewide jewelry screening program, were studied to determine the frequency of carcinoma and other skin problems on the ring finger. Severity of skin problems increased with increasing length of wear. Forty-one of the exposures were associated with mild to severe skin problems. Nine of the individuals studied were diagnosed as having histologically confirmed squamous cell carcinomas at the site of exposure. The incidence of skin cancer on the ring finger was eleven times that expected for men and forty-five times that expected for women. These data indicate that physicians who have patients with skin lesions of the ring finger should be aware of the possibility of exposure to a radioactive gold ring.