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Li Y, Millikan RC, Bell DA, Cui L, Tse CKJ, Newman B, Conway K. Cigarette smoking, cytochrome P4501A1 polymorphisms, and breast cancer among African-American and white women. Breast Cancer Res 2004; 6:R460-73. [PMID: 15217514 PMCID: PMC468667 DOI: 10.1186/bcr814] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Revised: 05/06/2004] [Accepted: 05/14/2004] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Previous epidemiologic studies suggest that women with variant cytochrome P4501A1 (CYP1A1) genotypes who smoke cigarettes are at increased risk for breast cancer. METHODS We evaluated the association of breast cancer with CYP1A1 polymorphisms and cigarette smoking in a population-based, case-control study of invasive breast cancer in North Carolina. The study population consisted of 688 cases (271 African Americans and 417 whites) and 702 controls (285 African Americans and 417 whites). Four polymorphisms in CYP1A1 were genotyped using PCR/restriction fragment length polymorphism analysis: M1 (also known as CYP1A1*2A), M2 (CYP1A1*2C), M3 (CYP1A1*3), and M4 (CYP1A1*4) RESULTS No associations were observed for CYP1A1 variant alleles and breast cancer, ignoring smoking. Among women who smoked for longer than 20 years, a modest positive association was found among women with one or more M1 alleles (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.2-3.5) but not among women with non-M1 alleles (OR = 1.2, 95% CI = 0.9-1.6). Odds ratios for smoking longer than 20 years were higher among African-American women with one or more M3 alleles (OR = 2.5, 95% CI = 0.9-7.1) compared with women with non-M3 alleles (OR = 1.3, 95% CI = 0.8-2.2). ORs for smoking in white women did not differ appreciably based upon M2 or M4 genotypes. CONCLUSIONS Cigarette smoking increases breast cancer risk in women with CYP1A1 M1 variant genotypes and in African-American women with CYP1A1 M3 variant genotypes, but the modifying effects of the CYP1A1 genotype are quite weak.
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Affiliation(s)
- Yu Li
- Department of Epidemiology, School of Public Heath and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert C Millikan
- Department of Epidemiology, School of Public Heath and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Douglas A Bell
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Lisa Cui
- Department of Epidemiology, School of Public Heath and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chiu-Kit J Tse
- Department of Epidemiology, School of Public Heath and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Beth Newman
- School of Public Health, Queensland University of Technology, Kelvin Grove, Australia
| | - Kathleen Conway
- Department of Epidemiology, School of Public Heath and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Buchbinder SP, Metch B, Holte SE, Scheer S, Coletti A, Vittinghoff E. Determinants of Enrollment in a Preventive HIV Vaccine Trial. J Acquir Immune Defic Syndr 2004; 36:604-12. [PMID: 15097304 DOI: 10.1097/00126334-200405010-00009] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare hypothetical and actual willingness to enroll in a preventive HIV vaccine trial and identify factors affecting enrollment. METHODS Participants previously enrolled in an HIV vaccine preparedness study (VPS) in 8 US cities were invited to be screened for a phase 2 HIV vaccine trial. Demographic and risk characteristics of those enrolling, ineligible, and refusing enrollment were compared using the chi2 or Fisher exact test. Multivariable logistic models were used to identify independent predictors of refusal. RESULTS Of 2531 high-risk HIV-uninfected former VPS participants contacted for the vaccine trial, 13% enrolled, 34% were ineligible, and 53% refused enrollment. Only 20% of those stating hypothetical willingness during the VPS actually enrolled in this vaccine trial. In multivariate analysis, refusal was higher among African Americans and lower in persons >40 years of age, those attending college, and those with > or =5 partners in the prior 6 months. All racial ethnic groups cited concerns about vaccine-induced seropositivity; African Americans also cited mistrust of government and safety concerns as barriers to enrollment. CONCLUSIONS Steps can be taken to minimize potential social harms and to mobilize diverse communities to enroll in trials. Statements of hypothetical willingness to participate in future trials may overestimate true enrollment.
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Affiliation(s)
- Susan P Buchbinder
- AIDS Office, San Francisco Department of Public Health, San Francisco, CA 94102-6033, USA.
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Satia-Abouta J, Galanko JA, Martin CF, Ammerman A, Sandler RS. Food groups and colon cancer risk in African-Americans and Caucasians. Int J Cancer 2004; 109:728-36. [PMID: 14999782 DOI: 10.1002/ijc.20044] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The disparities in colon cancer incidence between African-Americans and other U.S. ethnic groups are largely unexplained. This report examines associations of various food groups with colon cancer in African-Americans and Caucasians from a case-control study. Incident cases of histologically confirmed colon cancer, age 40-80 years, (n = 613) and matched controls (n = 996) were interviewed in-person to ascertain potential colon cancer risk factors. Diet over the year before diagnosis or interview date was assessed using a validated food frequency questionnaire adapted to include regional foods. Multivariate logistic regression models estimated energy-adjusted and non-energy adjusted odds ratios (OR). Controls generally reported higher consumption (daily amount and weekly frequency) of fruits, vegetables and dark green, deep yellow fruits/vegetables, whereas cases consumed more refined carbohydrates and fats, oils and snacks. Regardless of ethnic group or energy adjustment, high and frequent vegetable consumption (particularly dark green vegetables) was protective, consistent with 20-50% reductions in risk. In Caucasians, high refined carbohydrate and red meat consumption (amount and frequency) was associated with a statistically significant 2-fold increased risk in non-energy adjusted models. In African-Americans, frequent intake of dairy foods was associated with a doubling in risk (OR = 1.9, 95% CI = 1.1-3.4) in non-energy-adjusted models, whereas frequent fruit consumption correlated with a non-significant 30% lower risk. These findings add to growing evidence that plant foods may protect against colon cancer; however, the effects of the other food groups varied by ethnic group and energy adjustment. These results may also explain some of the ethnic differences in colon cancer incidence.
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Affiliation(s)
- Jessie Satia-Abouta
- Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill, 4106 MacGavran Greenberg Hall, Campus Box 7461, Chapel Hill, NC 27599, USA.
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Millikan RC, Player J, de Cotret AR, Moorman P, Pittman G, Vannappagari V, Tse CKJ, Keku T. Manganese superoxide dismutase Ala-9Val polymorphism and risk of breast cancer in a population-based case-control study of African Americans and whites. Breast Cancer Res 2004; 6:R264-74. [PMID: 15217492 PMCID: PMC468618 DOI: 10.1186/bcr786] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Revised: 03/01/2004] [Accepted: 03/11/2004] [Indexed: 12/05/2022] Open
Abstract
Introduction A polymorphism in the manganese superoxide dismutase (MnSOD) gene, Ala-9Val, has been examined in association with breast cancer risk in several epidemiologic studies. Results suggest that the Ala allele increases the risk of breast cancer and modifies the effects of environmental exposures that produce oxidative damage to DNA. Methods We examined the role of the MnSOD Ala-9Val polymorphism in a population-based case–control study of invasive and in situ breast cancer in North Carolina. Genotypes were evaluated for 2025 cases (760 African Americans and 1265 whites) and for 1812 controls (677 African Americans and 1135 whites). Results The odds ratio for MnSOD Ala/Ala versus any MnSOD Val genotypes was not elevated in African Americans (odds ratio = 0.9, 95% confidence interval = 0.7–1.2) or in whites (odds ratio = 1.0, 95% confidence interval = 0.8–1.2). Greater than additive joint effects were observed for the Ala/Ala genotype and smoking, radiation to the chest, and occupational exposure to ionizing radiation. Antagonism was observed between the Ala/Ala genotype and the use of nonsteroidal anti-inflammatory drugs. Conclusions The MnSOD genotype may contribute to an increased risk of breast cancer in the presence of specific environmental exposures. These results provide further evidence for the importance of reactive oxygen species and of oxidative DNA damage in the etiology of breast cancer.
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Affiliation(s)
- Robert C Millikan
- Department of Epidemiology, School of Public Health, and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jon Player
- Department of Epidemiology, School of Public Health, and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allan René de Cotret
- Department of Epidemiology, School of Public Health, and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Patricia Moorman
- Department of Community and Family Medicine, Duke University, Medical Center, Durham, North Carolina, USA
| | - Gary Pittman
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Vani Vannappagari
- Department of Epidemiology, School of Public Health, and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chiu-Kit J Tse
- Department of Epidemiology, School of Public Health, and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Temitope Keku
- Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Horn-Ross PL, John EM, Canchola AJ, Stewart SL, Lee MM. Phytoestrogen intake and endometrial cancer risk. J Natl Cancer Inst 2003; 95:1158-64. [PMID: 12902445 DOI: 10.1093/jnci/djg015] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The development of endometrial cancer is largely related to prolonged exposure to unopposed estrogens. Phytoestrogens (i.e., weak estrogens found in plant foods) may have antiestrogenic effects. We evaluated the associations between dietary intake of seven specific compounds representing three classes of phytoestrogens (isoflavones, coumestans, and lignans) and the risk of endometrial cancer. METHODS In a case-control study from the greater San Francisco Bay Area, we collected dietary information from 500 African American, Latina, and white women aged 35-79 years who were diagnosed with endometrial cancer between 1996 and 1999 and from 470 age- and ethnicity-matched control women identified through random-digit dialing. Unconditional logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Isoflavone (OR = 0.59, 95% CI = 0.37 to 0.93 for the highest versus lowest quartile of exposure) and lignan (OR = 0.68, 95% CI = 0.44 to 1.1) consumptions were inversely related to the risk of endometrial cancer. These associations were slightly stronger in postmenopausal women (OR = 0.44, 95% CI = 0.26 to 0.77 and OR = 0.57, 95% CI = 0.34 to 0.97 for isoflavones and lignans, respectively). Obese postmenopausal women consuming relatively low amounts of phytoestrogens had the highest risk of endometrial cancer (OR = 6.9, 95% CI = 3.3 to 14.5 compared with non-obese postmenopausal women consuming relatively high amounts of isoflavones); however, the interaction between obesity and phytoestrogen intake was not statistically significant. CONCLUSION Some phytoestrogenic compounds, at the levels consumed in the typical American-style diet, are associated with reduced risk of endometrial cancer.
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Bernstein L, Teal CR, Joslyn S, Wilson J. Ethnicity-related variation in breast cancer risk factors. Cancer 2003; 97:222-9. [PMID: 12491485 DOI: 10.1002/cncr.11014] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A variety of factors are predictors of breast cancer risk. However, the studies conducted to establish these risk factors have rarely included African American women. The few studies with sufficient numbers of African-American women suggest that risk factors for breast cancer among African-American women are similar to those of white women. Although risk factors may be similar for African-American and white women, differences in the prevalence of risk factors may explain the differences in patterns of incidence. METHODS The authors reviewed the epidemiologic studies of breast cancer among African-American women and identified resources with information regarding the prevalence of risk factors among African American and white women. RESULTS Considerable variation exists in the studies of breast cancer risk factors among African American women. Because few studies have included sufficient numbers of African-American women, no firm conclusions can be drawn regarding whether risk estimates for African American women differ from those of white women. Estimates of the prevalence of breast cancer risk factors indicate that African American and white women differ in terms of their ages at menarche, menstrual cycle patterns, birth rates, lactation histories, patterns of oral contraceptive use, levels of obesity, frequency of menopausal hormone use, physical activity patterns, and alcohol intake. CONCLUSIONS The risk factor profile of African-American women appears to differ from that of white women. This may explain in part, the higher incidence rates for African Americans before age 45 years and the lower incidence rates at older ages. Discussions of these data at a workshop highlighted the need for future research on breast cancer risk among African Americans. This research should acknowledge the heterogeneous heritage, cultural beliefs, and cultural knowledge of African-American women. Studies conducted in collaboration with the African-American community of women and with the breast cancer advocacy community can benefit from assistance in the design of questionnaires and recruitment of participants.
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Affiliation(s)
- Leslie Bernstein
- Department of Preventive Medicine/USC Norris Cancer Center, University of Southern California, Los Angeles, California 90033, USA.
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Abstract
BACKGROUND The effect of potential endocrine-modulating organochlorines on menopause has not been extensively examined. METHODS We evaluated the associations of plasma polychlorinated biphenyls (PCBs) and 1,1-dichloro-2,2-bis( -chlorophenyl)ethylene (DDE) with age at natural menopause. We analyzed data from 1407 women in a population-based, case-control study of breast cancer that was carried out in 1993-1996 in North Carolina. RESULTS The adjusted hazard ratio estimating the rate of onset of natural menopause was 1.4 (95% confidence interval = 0.9-2.1) for the top decile of DDE compared with values below the median. This association is similar in magnitude to the association between smoking and menopause (hazard ratio = 1.4 [1.1-1.9]). No association was seen with PCBs. CONCLUSIONS The suggested effect of DDE on timing of natural menopause encourages further research to corroborate these findings and evaluate potential mechanisms. Prospective studies, in which exposure measurements are taken before menopause, would be particularly useful.
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Affiliation(s)
- Glinda S Cooper
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA.
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108
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Parks CG, Cooper GS, Nylander-French LA, Sanderson WT, Dement JM, Cohen PL, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS, Hoppin JA, Savitz DA. Occupational exposure to crystalline silica and risk of systemic lupus erythematosus: a population-based, case-control study in the southeastern United States. ARTHRITIS AND RHEUMATISM 2002; 46:1840-50. [PMID: 12124868 DOI: 10.1002/art.10368] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Crystalline silica may act as an immune adjuvant to increase inflammation and antibody production, and findings of occupational cohort studies suggest that silica exposure may be a risk factor for systemic lupus erythematosus (SLE). We undertook this population-based study to examine the association between occupational silica exposure and SLE in the southeastern US. METHODS SLE patients (n = 265; diagnosed between January 1, 1995 and July 31, 1999) were recruited from 4 university rheumatology practices and 30 community-based rheumatologists in 60 contiguous counties. Controls (n = 355), frequency-matched to patients by age, sex, and state of residence, were randomly selected from driver's license registries. The mean age of the patients at diagnosis was 39 years; 91% were women and 60% were African American. Detailed occupational and farming histories were collected by in-person interviews. Silica exposure was determined through blinded assessment of job histories by 3 industrial hygienists, and potential medium- or high-level exposures were confirmed through followup telephone interviews. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression. RESULTS More patients (19%) than controls (8%) had a history of medium- or high-level silica exposure from farming or trades. We observed an association between silica and SLE (medium exposure OR 2.1 [95% CI 1.1-4.0], high exposure OR 4.6 [95% CI 1.4-15.4]) that was seen in separate analyses by sex, race, and at different levels of education. CONCLUSION These results suggest that crystalline silica exposure may promote the development of SLE in some individuals. Additional research is recommended in other populations, using study designs that minimize potential selection bias and maximize the quality of exposure assessment.
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Affiliation(s)
- Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina 27709, USA.
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Cooper GS, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS. Hormonal and reproductive risk factors for development of systemic lupus erythematosus: results of a population-based, case-control study. ARTHRITIS AND RHEUMATISM 2002; 46:1830-9. [PMID: 12124867 DOI: 10.1002/art.10365] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Estrogen and prolactin may accelerate the progression of murine systemic lupus erythematosus (SLE). In humans, 85% of lupus patients are women, which also suggests the importance of hormonal factors in disease pathogenesis. The purpose of this study was to examine hormonal and reproductive risk factors for lupus among women. METHODS This population-based, case-control study included 240 female SLE patients diagnosed between January 1, 1995 and July 31, 1999 who fulfilled the American College of Rheumatology classification criteria. Female controls (n = 321) were identified through driver's license records. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) as measures of association, adjusting for age, state, race, and education. Analyses were limited to exposures before diagnosis. RESULTS Breast-feeding was associated with a decreased risk of developing SLE (OR 0.6, 95% CI 0.4-0.9), with a statistically significant trend for number of babies breast-fed and total weeks of breast-feeding. There were no associations with number of pregnancies or live births. Natural menopause occurred earlier in women with subsequent development of SLE compared with controls (P < 0.001). There was little association between SLE and current use or duration of use of hormone replacement therapy or oral contraceptives, and no association with previous use of fertility drugs. CONCLUSION We found little evidence that estrogen- or prolactin-related exposures are associated with an increased risk of lupus. The reduced risk observed among women who had breast-fed one or more babies should be examined in other studies. Early natural menopause, rather than decreasing risk of SLE because of reduced estrogen exposure, may be a marker of susceptibility to development of SLE.
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Affiliation(s)
- Glinda S Cooper
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina 27709, USA.
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Gammon MD, Neugut AI, Santella RM, Teitelbaum SL, Britton JA, Terry MB, Eng SM, Wolff MS, Stellman SD, Kabat GC, Levin B, Bradlow HL, Hatch M, Beyea J, Camann D, Trent M, Senie RT, Garbowski GC, Maffeo C, Montalvan P, Berkowitz GS, Kemeny M, Citron M, Schnabe F, Schuss A, Hajdu S, Vincguerra V, Collman GW, Obrams GI. The Long Island Breast Cancer Study Project: description of a multi-institutional collaboration to identify environmental risk factors for breast cancer. Breast Cancer Res Treat 2002; 74:235-54. [PMID: 12206514 DOI: 10.1023/a:1016387020854] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Long Island Breast Cancer Study Project is a federally mandated, population-based case-control study to determine whether breast cancer risk among women in the counties of Nassau and Suffolk, NY, is associated with selected environmental exposures, assessed by blood samples, self-reports, and environmental home samples. This report describes the collaborative project's background, rationale, methods, participation rates, and distributions of known risk factors for breast cancer by case-control status, by blood donation, and by availability of environmental home samples. Interview response rates among eligible cases and controls were 82.1% (n = 1,508) and 62.8% (n = 1,556), respectively. Among case and control respondents who completed the interviewer-administered questionnaire, 98.2 and 97.6% self-completed the food frequency questionnaire; 73.0 and 73.3% donated a blood sample; and 93.0 and 83.3% donated a urine sample. Among a random sample of case and control respondents who are long-term residents, samples of dust (83.6 and 83.0%); soil (93.5 and 89.7%); and water (94.3 and 93.9%) were collected. Established risk factors for breast cancer that were found to increase risk among Long Island women include lower parity, late age at first birth, little or no breast feeding, and family history of breast cancer. Factors that were found to be associated with a decreased likelihood that a respondent would donate blood include increasing age and past smoking; factors associated with an increased probability include white or other race, alcohol use, ever breastfed, ever use of hormone replacement therapy, ever use of oral contraceptives, and ever had a mammogram. Long-term residents (defined as 15+ years in the interview home) with environmental home samples did not differ from other long-term residents, although there were a number of differences in risk factor distributions between long-term residents and other participants, as anticipated.
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Affiliation(s)
- Marilie D Gammon
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA.
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Plummer P, Jackson S, Konarski J, Mahanna E, Dunmore C, Regan G, Mattingly D, Parker B, Williams S, Andrews C, Vannapppagari V, Hall S, Deming S, Hodgson E, Moorman P, Newman B, Millikan R. Making epidemiologic studies responsive to the needs of participants and communities: the Carolina Breast Cancer Study experience. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2002; 39:96-101. [PMID: 11921175 DOI: 10.1002/em.10045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this report, we present the results of surveys administered to participants and nonparticipants in the Carolina Breast Cancer Study (CBCS). Surveys and structured interviews were administered to determine women's concerns regarding participation in research studies, access to health care, and beliefs regarding causes of breast cancer. Survey results showed the highest concern for the growing number of women diagnosed with breast cancer in North Carolina and potential environmental agents that may cause breast cancer. Negative responses were noted for time constraints related to participation and lack of familiarity with epidemiologic research; another concern noted was the lack of centralized information regarding breast cancer treatment. These issues were addressed by (1) developing a web site that provided background information about the CBCS, summaries of published study results, and information about the etiology of breast cancer; and (2) creating a statewide, comprehensive breast cancer resource directory for women who need information about breast cancer diagnosis, treatment, and support. These two projects were carried out in collaboration with breast cancer advocates, and demonstrate the important role that advocates can play in making epidemiologic research more responsive to the needs of communities.
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Affiliation(s)
- Patricia Plummer
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599-7435, USA
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112
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Abstract
OBJECTIVES This study examined whether area-level characteristics are associated with individual smoking behavior among women. METHODS Analyses included 648 women enrolled as control patients in the Carolina Breast Cancer Study (1993-1996). Smoking and covariate information was obtained from interviews. Area-level characteristics included census block-group education level, poverty, unemployment, car-home ownership, crowding, and, for 431 women, city-level crime rates. RESULTS In multivariate logistic regression models, no area characteristics were clearly associated with a history of smoking. Among those who had ever smoked, continued smoking was associated with living in low-education areas (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.0, 2.9), high-unemployment areas (OR = 1.7, 95% CI = 1.0, 2.8), and high-crime areas (OR = 1.6, 95% CI = 0.8, 3.2). CONCLUSIONS The present findings are consistent with a growing literature suggesting that area-level social and economic disadvantage influences individual smoking behavior.
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Affiliation(s)
- M Tseng
- Division of Population Science, Fox Chase Cancer Center, Philadelphia, Pa 19111, USA.
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113
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Van Wijngaarden E, Nylander-French LA, Millikan RC, Savitz DA, Loomis D. Population-based case-control study of occupational exposure to electromagnetic fields and breast cancer. Ann Epidemiol 2001; 11:297-303. [PMID: 11399443 DOI: 10.1016/s1047-2797(01)00209-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This population-based case-control study examined occupational exposure to electromagnetic fields in relation to female breast cancer incidence among 843 breast cancer cases and 773 controls. METHODS Exposure was classified based on work in the two longest-held jobs, and indices of cumulative exposure to magnetic fields based on a measurement survey. RESULTS Female breast cancer was not associated with employment as an office or industrial worker. For the total study population, cumulative exposure over the entire career, and in the past 0-10 and 10-20 years generally showed odds ratios (ORs) close to the null. Moderately elevated risks were found for intermediate but not high levels of cumulative exposure accumulated 20 or more years ago (OR = 1.5; 95% CI = 1.1-2.0). Associations were stronger for premenopausal women (OR = 1.7; 95% CI = 1.1-2.7) in the past 10-20 years, and those with estrogen-receptor positive (ER+) breast tumors (OR = 2.06; 95% CI = 1.1-4.0). No consistent dose-response patterns were observed. CONCLUSIONS These findings give little support to the hypothesis that electromagnetic fields cause cancer of the female breast.
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Affiliation(s)
- E Van Wijngaarden
- Departments of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Moorman PG, Ricciuti MF, Millikan RC, Newman B. Vitamin supplement use and breast cancer in a North Carolina population. Public Health Nutr 2001; 4:821-7. [PMID: 11415490 DOI: 10.1079/phn2001121] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Laboratory data suggest that several different vitamins may inhibit the growth of mammary cancers, however epidemiologic data on the relationship between vitamin supplement use and breast cancer are inconsistent. We examined the association between self-reported vitamin supplement use and breast cancer among black women and white women. DESIGN AND SETTING The data came from a population-based, case-control study conducted in North Carolina between 1993 and 1996. Logistic regression models were used to calculate adjusted odds ratios (ORs) for breast cancer associated with the use of multivitamins or individual vitamin supplements. SUBJECTS Eligible cases were aged 20 to 74, and approximately 40% of the study population were black women. The analyses included 861 cases and 790 controls. RESULTS Among all women, there was little evidence for an association between any vitamin supplement and breast cancer. Modest inverse associations were observed among white women for use of multivitamins 95% confidence interval (CI): 0.59-1.12), vitamin C 95% CI: 0.54-1.14) and vitamin E 95% CI: 0.49-1.13). There was no evidence that vitamin supplements reduced the risk of breast cancer among black women. CONCLUSIONS This study provided very limited support for the hypothesis that vitamin supplements may reduce the risk of breast cancer. Although dietary factors are likely an important influence in breast cancer aetiology, reductions in risk are most likely to be achieved through dietary modification rather than through vitamin supplementation.
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Affiliation(s)
- P G Moorman
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
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Brown BA, Long HL, Weitz TA, Milliken N. Challenges of recruitment: focus groups with research study recruiters. Women Health 2001; 31:153-66. [PMID: 11289684 DOI: 10.1300/j013v31n02_08] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To rectify the historic lack of research on women's health and the exclusion of women from many significant clinical trials, regulations have been promulgated requiring the inclusion of women and minorities in research studies. Acknowledging that the National Institutes of Health (NIH) mandate has resulted in more inclusive research, the unintended consequences associated with implementation of these regulations must also be explored. While the requirements preclude the use of cost as a reason for excluding women and/or minorities, the additional funding necessary to recruit adequate numbers of study participants has not been provided. Consequently, study recruiters often face unacknowledged expectations and job pressures as they attempt to meet recruitment goals. While it is important to support the NIH mandate, the additional stress imposed upon research study recruiters must also be recognized. Focus groups with study recruiters from various backgrounds and types of research provide an understanding of the challenges recruiters face when attempting to recruit diverse populations of women into research, and provide an understanding of the impact of recruitment goals on study recruiters' job satisfaction.
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Affiliation(s)
- B A Brown
- UCSF National Center of Exellence in Women's Health, University of California, San Francisco, USA.
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116
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Moorman PG, Jones BA, Millikan RC, Hall IJ, Newman B. Race, anthropometric factors, and stage at diagnosis of breast cancer. Am J Epidemiol 2001; 153:284-91. [PMID: 11157416 DOI: 10.1093/aje/153.3.284] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A recent study suggested that the greater prevalence of severe obesity among African-American women explained almost one third of the observed differences between African-American and White women in stage at diagnosis of breast cancer. The objective of this investigation was to attempt to replicate these findings in a second, larger population and to expand the analyses by including a measure of body fat distribution, the waist:hip ratio. The authors used data from a population-based study in North Carolina comprising 791 breast cancer cases (302 in African-American women and 489 in White women) diagnosed between 1993 and 1996. African-American women were more likely to have later-stage (TNM stage >/=II) breast cancer (odds ratio (OR) = 2.2; 95% confidence interval (CI): 1.6, 2.9). They also were much more likely to be severely obese (body mass index >/=32.3) (OR = 9.7; 95% CI: 6.5, 14.5) and to be in the highest tertile of waist:hip ratio (OR = 5.7; 95% CI: 3.8, 8.6). In multivariate logistic regression models, adjustment for waist:hip ratio reduced the odds ratio for later-stage disease in African-American women by 20%; adjustment for both waist:hip ratio and severe obesity reduced the odds ratio by 27%. These observations suggest that obesity and body fat distribution, in addition to socioeconomic and medical care factors, contribute to racial differences in stage at breast cancer diagnosis.
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Affiliation(s)
- P G Moorman
- Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, CT, USA.
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117
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Duell EJ, Millikan RC, Savitz DA, Newman B, Smith JC, Schell MJ, Sandler DP. A population-based case-control study of farming and breast cancer in North Carolina. Epidemiology 2000; 11:523-31. [PMID: 10955404 DOI: 10.1097/00001648-200009000-00007] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined the role of farming and pesticide exposure among 862 cases and 790 controls in a population-based, case-control study of breast cancer conducted in North Carolina between 1993 and 1996. We obtained exposure information through personal interview. Increasing duration of farming was inversely associated with breast cancer risk; odds ratios (95% confidence intervals) were 1.2 (0.8-1.7), 0.8 (0.5-1.2), 0.7 (0.5-1.1), and 0.6 (0.4-0.9) for 1-10, 11-17, 18-23, and >23 years of farming, respectively, relative to nonfarmers. Inverse associations persisted when farming was restricted to calendar time periods of 2,2-bis(p-chlorophenyl)- 1,1,1-trichloroethane (DDT) use or to farming at ages 9-16. Among women who farmed, odds ratios (ORs) were elevated for those who reported being present in fields during or shortly after pesticide application (OR = 1.8, 95% CI = 1.1-2.8) and for those who reported not using protective clothing while applying pesticides (OR = 2.0; 95% CI = 1.0-4.3), but not among those who reported using protective clothing (OR = 0.8; 95% CI = 0.4-1.8). We conclude that residence or work on farms may be associated with a reduced risk of breast cancer. Nevertheless, our results suggest a possible increased risk of breast cancer among a subgroup of farming women who were most likely to be exposed to pesticides.
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Affiliation(s)
- E J Duell
- Department of Epidemiology, School of Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 27599-7400, USA
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118
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Moorman PG, Kuwabara H, Millikan RC, Newman B. Menopausal hormones and breast cancer in a biracial population. Am J Public Health 2000; 90:966-71. [PMID: 10846517 PMCID: PMC1446270 DOI: 10.2105/ajph.90.6.966] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined the association between menopausal hormones and breast cancer in a biracial population. METHODS Logistic regression was used to calculate odds ratios for breast cancer associated with hormone use among 397 cases and 425 controls, all menopausal women. RESULTS Odds ratios for ever use of hormones were 0.8 (95% confidence interval [CI] = 0.5, 1.2) for White women and 0.7 (95% CI = 0.4, 1.2) for Black women. Risk was not increased with longer duration of use or more recent use. CONCLUSIONS Breast cancer risk was not increased among White or Black women who used menopausal hormones, despite patterns of use varying considerably between races.
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Affiliation(s)
- P G Moorman
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn., USA.
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119
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Marcus PM, Baird DD, Millikan RC, Moorman PG, Qaqish B, Newman B. Adolescent reproductive events and subsequent breast cancer risk. Am J Public Health 1999; 89:1244-7. [PMID: 10432916 PMCID: PMC1508686 DOI: 10.2105/ajph.89.8.1244] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study investigated the relationship between reproductive events during adolescence and subsequent breast cancer risk. METHODS Logistic regression models used self-reported data from 862 case patients and 790 controls in the Carolina Breast Cancer Study. RESULTS Miscarriage, induced abortion, and full-term pregnancy before 20 years of age were not associated with breast cancer. Among premenopausal women, breast-feeding before 20 years of age was inversely associated with disease. Oral contraceptive use before 18 years of age was positively associated with disease risk among African American women only. CONCLUSIONS Pregnancy during adolescence does not appear to influence breast cancer risk, but breast-feeding may. A possible increased breast cancer risk among African American women who used oral contraceptives as adolescents warrants further study.
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Affiliation(s)
- P M Marcus
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892-7354, USA.
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