Background A recent consensus statement encouraged use of certain symptoms to diagnose ovarian cancer earlier. We assessed the sensitivity, specificity, and positive predictive value of a proposed ...symptom index and of symptoms included in the consensus recommendation. Methods In-person interviews were conducted with 812 case patients, aged 35–74 years, who had epithelial ovarian cancer that was diagnosed from January 1, 2002, through December 31, 2005, and with 1313 population-based control subjects. The symptom index was considered positive when pelvic or abdominal pain or bloating or feeling full was reported at least daily for at least 1 week, with an onset of less than 12 months before diagnosis or a reference date (for control subjects). The consensus criteria were considered fulfilled when any symptom above or urinary urgency or frequency was reported for at least 1 month, with an onset of less than 12 months before diagnosis or a reference date. Positive predictive value was calculated by use of external estimates of cancer prevalence. Results Most case patients who had a positive index or met consensus criteria did so only within 5 months before diagnosis. Symptoms (except nausea) were somewhat less likely to have occurred among women diagnosed with early-stage than late-stage ovarian cancer. The estimated positive predictive value of the symptom index or symptoms meeting the consensus criteria was 0.6%–1.1% overall and less than 0.5% for early-stage disease. Conclusion Use of symptoms to trigger medical evaluation for ovarian cancer is likely to result in diagnosis of the disease in only one of 100 women in the general population with such symptoms.
Breast-feeding and risk of epithelial ovarian cancer Jordan, S. J.; Cushing-Haugen, K. L.; Wicklund, K. G. ...
CCC. Cancer causes & control/CCC, Cancer causes & control,
06/2012, Letnik:
23, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Purpose: Evidence suggests that breast-feeding may decrease the risk of epithelial ovarian cancer but it is not clear whether there is a relationship with duration of breastfeeding, patterns of ...breast-feeding, or particular histological subtypes of ovarian cancer. We sought to investigate these issues in detail. Methods: Data from participants in a population-based study of ovarian cancer in western Washington State, USA (2002-2007) who had had at least one birth (881 cases and 1,345 controls) were used to assess relations between patterns of breast-feeding and ovarian cancer. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: Women who ever breast-fed had a 22 % reduction in risk of ovarian cancer compared with those who never breast-fed (OR = 0.78, 95% CI 0.64-0.96) and risk reduction appeared greater with longer durations of feeding per child breast-fed (OR = 0.56, 95% CI 0.32-0.98 for 18 months average duration breast-feeding versus none). Introduction of supplementary feeds did not substantially alter these effects. The overall risk reduction appeared greatest for the endometrioid and clear cell subtypes (OR per month of average breast-feeding per child breastfed = 0.944, 95% CI 0.903-0.987). Conclusions: Among women who have had the opportunity to breast-feed, ever breast-feeding and increasing durations of episodes of breast-feeding for each breast-fed child are associated with a decrease in the risk of ovarian cancer independent of numbers of births, which may be strongest for the endometrioid subtype.
Body Mass Index, Weight, and Oral Contraceptive Failure Risk Holt, Victoria L.; Scholes, Delia; Wicklund, Kristine G. ...
Obstetrics and gynecology (New York. 1953),
2005-January, 2005, 2005-Jan, 2005-01-00, 20050101, Letnik:
105, Številka:
1
Journal Article
Recenzirano
OBJECTIVE:This project was supported by grant 1 R01 HD-34712 from the U.S. National Institute of Child Health and Human Development.To estimate the effect of body mass index (BMI) and weight on risk ...of pregnancy while using oral contraceptives (OCs).
METHODS:We conducted a case-control study of 248 health maintenance organization enrollees who became pregnant while using OCs between 1998 and 2001 and 533 age-matched enrollees who were nonpregnant OC users during the same period. Using logistic regression we calculated adjusted odds ratios (ORs) to estimate the risk of pregnancy according to BMI and weight quartile.
RESULTS:Among all OC users, when compared with women having a BMI of 27.3 or less, the risk of pregnancy was nearly 60% higher in women with BMI greater than 27.3 (OR 1.58, 95% confidence interval CI 1.11–2.24) and over 70% higher in women with BMI greater than 32.2 (OR 1.72, 95% CI 1.04–2.82). Among consistent users (women who missed no pills in reference month), the risk of pregnancy was more than doubled in women with BMI greater than 27.3 (OR 2.17, 95% CI 1.38–3.41) or BMI greater than 32.2 (OR 2.22, 95% CI 1.18–4.20). When compared with women weighing 74.8 kg or less, among consistent OC users the risk of pregnancy was over 70% higher in women weighing more than 74.8 kg (OR 1.71, 95% CI 1.08–2.71) and nearly doubled in women weighing more than 86.2 kg (OR 1.95, 95% CI 1.06–3.67).
CONCLUSION:Our results suggest that being overweight may increase the risk of becoming pregnant while using OCs. If causal, this association translates to an additional 2–4 pregnancies per 100 woman-years of use among overweight women, for whom consideration of additional or effective alternative contraceptive methods may be warranted.
LEVEL OF EVIDENCE:II-2
We analyzed the polymorphic (CAG)n and (GGN)n regions within the androgen receptor gene from participants in a population-based case-control study of prostate cancer in middle-aged (40-64 years) ...Caucasian men. The associations between repeat lengths and risk of prostate cancer and the effects of confounding and modifying factors, such as age, family history of prostate cancer, and body mass index, were evaluated. DNA was available for 301 cases and 277 controls. The overall age-adjusted relative odds of prostate cancer associated with the number of (CAG) repeats as a continuous variable was 0.97 95% confidence interval (CI), 0.92-1.03, suggesting a 3% decrease in risk of prostate cancer for each additional (CAG) repeat. Further analyses identified several subgroups at increased risk. These were men with less than the median number of CAG repeats (< 22) that were younger < 60 years; relative odds (RO), 1.47; 95% CI, 0.96-2.25, had an affected first-degree relative (RO, 1.59; 95% CI, 0.62-4.14), or were relatively thin (Quetelet index < 24.4; RO, 2.21; 95% CI, 1.07-4.69). Although only the latter result was statistically significant, these results are provocative and support the hypothesis that (CAG)n array length is a predictor of risk for prostate cancer. Similar analyses of (GGN)n showed that with the exception of men with a family history of prostate cancer and those in the highest quartile of body mass index, men with < or = 16 repeats had higher risk estimates than did men with > 16 repeats. Overall, those men who had < or = 16 repeats had a significant elevation in risk (RO, 1.60; 95% CI, 1.07-2.41). When both repeat lengths were considered jointly, the subgroup with two short repeats (CAG, < 22; GGN, < or = 16) had a 2-fold elevation in odds (RO, 2.05; 95% CI, 1.09-3.84) relative to those with two long repeats (CAG, > or = 22; GGN, > 16). These data suggest that determination of both androgen receptor repeats within germ-line DNA may be useful in assessing an individual's risk of developing prostate cancer.
Vasectomy and Risk of Prostate Cancer STANFORD, J. L; WICKLUND, K. G; MCKNIGHT, B ...
Cancer epidemiology, biomarkers & prevention,
10/1999, Letnik:
8, Številka:
10
Journal Article
Recenzirano
Most studies do not support an association between vasectomy and prostate cancer, but a few have suggested a link. Vasectomy
is a common birth control method, and prostate cancer is the most ...frequently diagnosed solid tumor in men, making this a major
public health question. This study was specifically designed to determine whether or not vasectomy is associated with risk
of prostate cancer. To examine this issue, we conducted a population-based case-control study in King County, Washington.
Interviews were completed with men ages 40–64 years newly diagnosed with prostate cancer between January 1993 and December
1996 who were ascertained through the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) cancer registry
( n = 753) and with comparison men without prostate cancer identified from the same general population ( n = 703). The odds ratio (OR) for prostate cancer in relation to vasectomy was assessed. The prevalence of vasectomy was similar
in cases (39.4%) and controls (37.7%), resulting in no association (adjusted OR, 1.10; 95% confidence interval, 0.9–1.4).
There was no consistent evidence that risk varied by the age at which vasectomy was performed, the time since vasectomy, or
the calendar period when the vasectomy was performed. The OR in relation to vasectomy was higher in men with less aggressive
prostate cancer. Risk estimates did not differ according to age, race, or family history of prostate cancer. This study suggests
that vasectomy is not associated with the risk of developing prostate cancer. It also provides evidence that vasectomized
men may be more likely to present with earlier-stage, lower-grade prostate tumors.
Unexpected findings from the Multiple Risk Factor Intervention Trial, a trial of the primary prevention of coronary heart disease, suggested that treating hypertension with high doses of thiazide ...diuretic drugs might increase the risk of sudden death from cardiac causes
1
–
4
. Meta-analyses of clinical trials evaluating the treatment of hypertensive patients with high doses of a thiazide suggest a reduction of 8 to 12 percent in mortality from coronary heart disease -- substantially less than the reduction of 20 to 25 percent predicted in epidemiologic studies
5
,
6
. In recent clinical trials, in contrast, the treatment of hypertensive patients . . .
Sexual Factors and the Risk of Prostate Cancer Rosenblatt, Karin A.; Wicklund, Kristine G.; Stanford, Janet L.
American journal of epidemiology,
06/2001, Letnik:
153, Številka:
12
Journal Article
Recenzirano
A population-based case-control study of prostate cancer was performed in King County, Washington, in White men and Black men aged 40–64 years, between 1993 and 1996. Incident prostate cancer cases ...(n = 753) were identified from the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) cancer registry. Controls (n = 703) were identified through random digit dialing and were frequency matched to cases on age. Sexual behavior, medical history, and other potential prostate cancer risk factors were ascertained through an in-person interview. There was no relation between sexual orientation and prostate cancer, although the number of men who had sex with men was small. Risk estimates increased directly with the lifetime number of female sexual partners (trend p < 0.001) but not with male partners (trend p = 0.62). Risk also increased with decreasing age at first intercourse, but this effect disappeared after adjusting for the number of female partners. Prior infection with gonorrhea was positively associated with risk (odds ratio = 1.50; 95% confidence interval: 1.0, 2.2), but no effect was seen among men with other sexually transmitted diseases. No relation between lifetime frequency of sexual intercourse and risk of prostate cancer was apparent. These findings are consistent with previous studies that support an infectious etiology for prostate cancer.
OBJECTIVE:To describe the association between postmenopausal estrogen-only therapy use and risk of ovarian carcinoma, specifically with regard to disease histotype and duration and timing of use.
...METHODS:We conducted a pooled analysis of 906 women with ovarian carcinoma and 1,220 women in a control group; all 2,126 women included reported having had a hysterectomy. Ten population-based case–control studies participating in the Ovarian Cancer Association Consortium, an international consortium whose goal is to combine data from many studies with similar methods so reliable assessments of risk factors can be determined, were included. Self-reported questionnaire data from each study were harmonized and conditional logistic regression was used to examine estrogen-only therapyʼs histotype-specific and duration and recency of use associations.
RESULTS:Forty-three and a half percent of the women in the control group reported previous use of estrogen-only therapy. Compared with them, current or recent estrogen-only therapy use was associated with an increased risk for the serous (51.4%, odds ratio OR 1.63, 95% confidence interval CI 1.27–2.09) and endometrioid (48.6%, OR 2.00, 95% CI 1.17–3.41) histotypes. In addition, statistically significant trends in risk according to duration of use were seen among current or recent postmenopausal estrogen-only therapy users for both ovarian carcinoma histotypes (Ptrend<.001 for serous and endometrioid). Compared with women in the control group, current or recent users for 10 years or more had increased risks of serous ovarian carcinoma (36.8%, OR 1.73, 95% CI 1.26–2.38) and endometrioid ovarian carcinoma (34.9%, OR 4.03, 95% CI 1.91–8.49).
CONCLUSION:We found evidence of an increased risk of serous and endometrioid ovarian carcinoma associated with postmenopausal estrogen-only therapy use, particularly of long duration. These findings emphasize that risk may be associated with extended estrogen-only therapy use.
The authors conducted a population-based case-control study of 410 women residing in three counties in western Washington State who were aged 18–64 years when diagnosed with papillary thyroid cancer ...in 1988–1994 and 574 controls to assess the effects of pregnancy history and other aspects of reproductive life on risk of this disease. Among women aged 45–64, the authors observed no associations with number of live births, age at first live birth, or age at last live birth. Risk was somewhat increased in women <45 years who had given birth within the previous 5 years; this association was most evident among women who reported that cancer symptoms had led to diagnosis. Among women who had given birth within the last 5 years, risk was greatest among those with two or more births during that time period (relative risk (RR) = 4.2, 95% confidence interval (Cl): 2.0, 8.9, relative to parous women whose last birth was >5 years before the reference date). Risk of thyroid cancer was also associated with lactation during the previous 5 years (e.g., RR = 2.9, 95% Cl: 1.5, 5.5, among parous women who had breastfed £12 months, vs. 0–1 months, during that interval). Our results suggest that thyroid stimulation during both pregnancy and lactation may result in a transient increase in risk of papillary thyroid cancer. Am J Epidemiol 2000;151:765–72.
Both smoking and alcohol consumption may influence thyroid function, although the nature of these relations is not well understood. We examined the influence of tobacco and alcohol use on risk of ...papillary thyroid cancer in a population-based case-control study. Of 558 women with thyroid cancer diagnosed during 1988-1994 identified as eligible, 468 (83.9%) were interviewed; this analysis was restricted to women with papillary histology (N = 410). Controls (N = 574) were identified by random digit dialing, with a response proportion of 73.6%. We used logistic regression to calculate odds ratios (OR) and associated confidence intervals (CI) estimating the relative risk of papillary thyroid cancer associated with cigarette smoking and alcohol consumption. A history of ever having smoked more than 100 cigarettes was associated with a reduced risk of disease (OR = 0.7, 95% CI = 0.5-0.9). This reduction in risk was most evident in current smokers (OR = 0.5, 95% CI = 0.4-0.7). Women who reported that they had ever consumed 12 or more alcohol-containing drinks within a year were also at reduced risk (OR 0.7, 95% CI = 0.5-1.0). Similar to the association noted with smoking, the reduction in risk was primarily present among current alcohol consumers. The associations we observed, if not due to chance, may be related to actions of cigarette smoking and alcohol consumption that reduce thyroid cell proliferation through effects on thyroid stimulating hormone, estrogen, or other mechanisms.
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