Coffee drinking and cancer of the lower urinary tract.

The relation of coffee drinking to the incidence rate of cancer of the lower urinary tract ("bladder cancer") was evaluated. Broadly based series of cases and series of controls drawn from the general population of each area were assembled and interviewed in Boston, Massachusetts (587 cases, 528 controls), Manchester, England (541 cases, 725 controls), and Nagoya, Japan (289 cases, 586 controls). Compared to drinkers of an average of less than 1 cup of coffee per day, those who drank more had a relative risk of bladder cancer estimated as 1.0 (0.8-1.2, 95% confidence interval). With adjustment for cigarette smoking habits, only small and irregular changes in risk were seen with increasing frequency of coffee consumption. Duration of coffee drinking showed little relation to risk of bladder cancer may be due to incomplete control of the effect of cigarette smoking. If there is a true association of coffee drinking and bladder cancer it is likely to be weak.

A multicentre study of coagulation and haemostatic variables during oral contraception: variations with geographical location and ethnicity. Task Force on Oral Contraceptives--WHO Special Programme of Research, Development and Research Training in Human Reproduction.

A comparative study of the effects of combined oral contraceptives (OC) on coagulation and fibrinolytic variables using standardized laboratory technique and methodology has been performed in Dublin (Ireland), Salvador (Brazil), Santiago (Chile) and Singapore. Of 777 entrants to the study, 622 were randomly allocated to receive one of four different OC formulations. The remainder did not opt for OC. The progestogenic component was levonorgestrel (LNG) in three of the OC formulations and norethisterone acetate (NEA) in the fourth. Results for the three LNG user groups were pooled. The changes in haematological variables observed over 12 months in the LNG and NEA users were examined in relation to the changes seen in the women not on OC. Women in Salvador differed markedly from those in the other three centres, in showing no acceleration of the prothrombin time and no increase in either fibrin plate lysis or plasminogen following the use of OC. After adjusting the findings in OC users for those in non-users, significant differences in response between centres were also detected for activated partial thromboplastin time (accelerated only in Dublin and Santiago), factor VII activity (increased mainly in Salvador and Santiago) and fibrinogen (for which the most marked changes were an increase in Dublin and a decrease in Salvador). This variability between centres in the effects of OC on coagulation and fibrinolysis suggests that OC administration in different populations may not carry equal thrombotic risks.

Birth prevalence of malformations in members of different ethnic groups and in the offspring of matings between them, in Birmingham, England.

STUDY OBJECTIVES: The aims were: (1) to compare the birth prevalence of malformations in different ethnic groups and (2) to explore the reasons for the ethnic variations found by examining birth prevalence in the offspring of matings between ethnic groups. DESIGN: Analysis of data from a register of malformations and register of births. SETTING: Birmingham, England. SUBJECTS: A total of 432,778 infants (including stillbirths) born in 1960-84. MAIN RESULTS: Significant differences (p < 0.01) between ethnic groups were exhibited by the birth prevalence of neural tube defects (NTD), cleft palate, cleft lip, oesophageal atresia/fistula, hypospadias, hip dislocation, clubfoot, polydactyly, and syndactyly. In the offspring of matings between parents of European and Caribbean origin, the birth prevalence of NTD, cleft lip, hypospadias, hip dislocation, polydactyly, and syndactyly seemed more likely to be influenced by the ethnicity of both parents than by that of the mother alone. The reverse was true for the birth prevalence of NTD in subjects with one parent of Irish origin and on of British. CONCLUSIONS: Genetic differences may be responsible for Europeans being at lower risk of polydactyly and at higher risk of NTD, cleft lip, hypospadias, hip dislocation, and syndactyly than Caribbeans. Variations in the intrauterine environment are more likely to account for NTD being more common in Irish than in British subjects.

Space-time interaction in Hodgkin's disease in Greater Manchester.

Knox's test for space-time interaction was applied to 922 cases of Hodgkin's disease which, according to the North Western Regional Cancer Registry, had presented in 1962-76 among the population of the region known before 1974 as the South East Lancashire Conurbation. In the series as a whole, there were statistically significant excesses of pairs of patients separated by time intervals of less than a year and distances of less than 1 km. Analysis by age and sex indicated that this clustering involved (a) a trio of young females and (b) pairs involving adults over 45 years old. No evidence was detected of any clustering by histological subtype or of any tendency for cases close in space to be separated by long time intervals of specific duration. These findings lend support to the idea that at least some cases of Hodgkin's disease may be induced by an infection or other environmental influence, but they do not suggest that such an infection has a long and specific incubation period.

Occupation and bladder cancer in Boston, USA, Manchester, UK, and Nagoya, Japan.

Relations between occupational history and the development of cancer of the lower urinary tract ("bladder cancer") were evaluated in Boston, Massachusetts, USA, Manchester, UK, and Nagoya, Japan. Population-based series of incident cases and controls were identified and interviewed in each area. The present analysis was limited to men and was based on 430 cases and 397 controls in Boston, 399 cases and 493 controls in Manchester, and 226 cases and 443 controls in Nagoya. In Boston, elevated risk of bladder cancer was associated with employment related to dyes (relative risk = 2 X 1; 90% confidence interval, 0 X 9-5 X 1), leather (1 X 7; 1 X 1-2 X 6), paint (1 X 5; 0 X 9-2 X 4), or organic chemicals (1 X 6; 1 X 1-2 X 5). In Manchester, elevated risk was associated with 0 X 9-3 X 6). No clear association was observed between occupation and risk in Nagoya. Elevations in risk related to occupation generally were stronger in men under 65 years of age compared to older men. Differences from place to place in associations between occupation and risk may be the result of differences in the exposures to hazardous agents that jobs with the same title involve.

Radical versus modified radical mastectomy for breast cancer.

A prospective randomised trial (534 patients, 1969-75) was designed to determine whether radical mastectomy conferred advantages over modified radical mastectomy for breast cancer in terms of total survival, local recurrence, distant metastasis, and disease-free interval. The results showed no significant difference in outcome as regards these variables between the two treatments.

McKeown, Record, and the epidemiology of malformations.

Thomas McKeown and RG Record were colleagues in Birmingham, England, from 1947 to 1977. During their first decade together, they laid the foundations of epidemiological research on malformations with a series of case-control studies of the commoner major defects. They found evidence of numerous trends of birth prevalence with variables such as season and year of birth, maternal age, birth rank, and socioeconomic status, suggesting that environmental factors played an important part in causation. The work that has led recently to the use of folate to reduce the risk of neural tube defects is among the lines of research that can be traced back to these case-control studies. McKeown and Record also initiated, in Birmingham, the first population-based register of malformations to be set up as an on-going activity. As well as paving the way for the international networks of registers that now exist, the Birmingham register has been used in a variety of cohort studies. This work has confirmed many of the case-control study findings and continues to yield new observations, including evidence that enteroviruses are involved in aetiology.

The north-south divide in England: implications for health care resource allocation.

Published regional data show that the Standardized Mortality Ratio (SMR) for the northern half of England has recently increased from 113 to 115 per cent of the SMR for the south, and that the north is at least as disadvantaged in respect of morbidity and material deprivation and uses much less private medical care than the south. It is concluded that the north's share of National Health Service (NHS) resources should not be reduced, as it would be if recent proposals by the NHS Management Board were implemented; that a mortality index which gives different weights to deaths at different ages should possibly be used instead of the simple SMR to weight regional resource allocations for need; and that these allocations should also be weighted by some measure of the extent to which regional populations look to the NHS rather than to the private sector for hospital and specialist care.

Incidence of neoplasms in children born after influenza epidemics.

Following a recent report that neoplasia of the lymphatic and haematopoietic tissues is commoner than average in children whose mothers have had influenza in pregnancy, the incidence of neoplasms in 1954-68 in children of the Manchester Hospital Region was examined in relation to date of birth. There were no significant differences between cohorts born in different quinquennia. Incidence among children born after six influenza epidemics in 1951-68 was no higher than among other children born in these years. It is concluded that if there is an association between maternal influenza and childhood neoplasia it is probably due to factors such as immunological deficiencies which may predispose independently to both conditions.

Incidence of cervical cancer by marital status.

The incidence of invasive cervical cancer by age and marital status was examined, using census statistics and 1968--71 cancer registry data from women who lived in the Manchester Regional Hospital Board area. The relative rarity of the disease in the unmarried and its higher incidence in formerly married than in currently married women was confirmed. This higher incidence was shown to be mainly in widows under 50 and divorced women, suggesting that it is related to the association of the disease with number of sexual partners.

Incidence of childhood tuberculosis after neonatal BCG vaccination.

Neonatal BCG vaccination has long been offered routinely to children born at St Mary's Hospital (SMH), Manchester, England, whereas the city's other obstetric hospitals have generally restricted this procedure to children of Asian origin and those with a family history of tuberculosis. Among children aged 0-14 years who had been born to Manchester residents in 1965-80, 65 presented with tuberculosis in 1975-80 whilst still resident in the city. The estimated incidence rate was less than half as high among all children born at SMH as among those not born there, largely because the rate for those born and vaccinated at SMH was less than one-quarter of that for those born elsewhere. Children with Bangladeshi, Indian, or Pakistani surnames also shared in the reduced risk associated with vaccination. These findings strongly support the effectiveness of neonatal BCG vaccination.

Incidence of myeloid leukaemia in Lancashire.

Identification of a "cluster" of cases of acute myeloid leukaemia and chronic myeloproliferative disorders in Lytham St. Annes, Lancashire, prompted an analysis of the incidence of myeloid leukaemias in Lancashire (excluding Ormskirk Health District), as recorded by the Manchester Cancer Registry. Although statistically there was no significant difference in the trend of incidence between the whole former borough of Lytham St. Annes and the other districts studied, the reported incidence of these diseases in the area as a whole had almost doubled, and in two districts nearly trebled, between two consecutive 6 year periods, beginning in 1965. This represents a substantially larger increase than mortality data suggests has occurred nationally in the same period, and is unlikely to be due solely to more accurate diagnosis or reporting.

Occupational exposure to hydrocarbons and chronic pancreatitis: a case-referent study.

OBJECTIVES: To investigate the hypothesis that hydrocarbon exposure is a risk factor for chronic pancreatitis. METHODS: 102 cases of chronic pancreatitis and 204 age and sex matched referents were interviewed about their occupational histories, alcohol and cigarette consumption, and diet. Exposure to hydrocarbons was inferred from interview responses by four assessors who were blind to disease state, and these data were then summarised by a cumulative hydrocarbon exposure (CHE) score. RESULTS: After adjustment for alcohol, cigarettes, dietary antioxidants, and social class, odds ratios for low CHE scores were 1.20 (90% CI: 0.62-2.35) and 2.67 (90% CI: 1.22-5.87) for high scores. A test for trend with level of exposure among only those who had exposure scores > 0 gave p = 0.09. Analysis by type of hydrocarbon was limited to four exposures for each of which there were at least 20 exposed patients. The adjusted OR for paint solvents (any level) was 0.96 (90% CI: 0.48-1.93); for diesel exhaust fumes OR = 2.66 (90% CI: 1.05-6.73); for petrochemicals OR = 1.82 (90% CI: 0.80-4.11); and for chlorinated solvents OR = 1.49 (90% CI: 0.58-3.81). CONCLUSIONS: These results support the original hypothesis. Further studies are needed to confirm or refute the findings here and to clarify the types of hydrocarbon involved.

The completeness and accuracy of health authority and cancer registry records according to a study of ovarian neoplasms.

The completeness and accuracy of Hospital Activity Analysis (HAA) and Regional Cancer Registry (RCR) records were investigated in a series of 868 histologically reviewed cases in which primary ovarian neoplasms had been diagnosed according to one or more of seven data sources including HAA and RCR. All the women concerned were residents of Manchester and Salford who had presented in 1979-83 aged 15 years or more. The histological review confirmed the diagnosis of ovarian neoplasia in 829 of these women and excluded it in 39. Among the 829 confirmed cases, 333 were malignant or of borderline malignancy and therefore eligible for registration with the RCR, and 496 were benign. Only 611 (74%) of the 829 cases were listed as ovarian neoplasms or cysts in HAA records of hospital admissions from the study area during the study period, and the HAA diagnosis was incorrect in 40% of the 611 listed cases. Among the 333 borderline or malignant cases, only 241 (72%) appeared among the RCR's registrations of ovarian neoplasms for the study period and area. The RCR record of histological diagnosis was inaccurate in over 20% of these 241 registered cases, although most of the inaccuracies did not affect whether the neoplasm was classified as borderline or malignant. Five per cent of the cases listed as ovarian neoplasms in the HAA file and 15% of those listed as registrable ovarian neoplasms by the RCR should not have been so listed. The findings highlight the limitations of these routine health information systems, both as sources of cases for research and as National Health Service management tools.

Artificial sweeteners and bladder cancer in Manchester, U.K., and Nagoya, Japan.

We have evaluated the relation between cancer of the lower urinary tract ("bladder cancer") and the use of artificial sweeteners, by means of case-control studies in Manchester, U.K., and Nagoya, Japan, areas where extensive use occurred 30-40 years ago. In each area, a broadly based series of cases (555 in Manchester, 293 in Nagoya) was interviewed and a series of controls (735 in Manchester, 589 in Nagoya) chosen from the general population. A history of use of sugar substitutes primarily saccharin, was not associated with an elevated risk of bladder cancer in either study area. Risk of bladder cancer did not increase regularly with frequency or duration of use of sugar substitutes. Data on dietetic beverages were not obtained in Nagoya. This exposure was not associated with a greater risk of bladder cancer in Manchester. The results of this study suggest that use of artificial sweeteners confers little or no risk of bladder cancer.