Infertility and risk of fatal ovarian cancer in a prospective cohort of US women

Objectives: It is difficult to separate the possible role of fertility drugs from underlying infertility as risk factors for ovarian cancer. The present study examined the relationship between self-reported infertility and death from ovarian cancer among married women unlikely to have been exposured to fertility drugs.Methods: Women were selected for study from the 676,526 female participants in Cancer Prevention Study II (CPS-II). After twelve years of follow-up, 797 deaths from ovarian cancer were observed among women with no prior history of cancer or hysterectomy and 40 years of age or older in 1967 when ovulatory stimulants were approved in the United States. Cox proportional hazards modeling was used to compute rate ratios (RRs) and to adjust for other potential risk factors.Results: Overall, self-reported infertility was not significantly associated with ovarian cancer mortality (adjusted rate ratio (RR)=1.1, 95 percent confidence interval (CI)=0.9-1.3). Ovarian cancer death rates among nulligravid women with self-reported infertility, however, were 40 percent higher than for nulligravid women who never tried to become pregnant (RR=1.4, 95 percent CI=0.9-2.4). Multigravid women who reported infertility problems were not at increased risk.Conclusions: These results suggest that infertility itself, without concomitant exposure to fertility drugs, may increase risk of fatal ovarian cancer among nulligravid women.     

Dietary cholesterol,fat, and lung cancer incidence among older women: The Iowa Women's Health Study (United States)

To test the hypothesis that a high intake of dietary cholesterol and fat is associated with elevated risks of lung cancer, we analyzed data from a population-based, prospective, cohort study conducted among 41,837 postmenopausal Iowa (United States) women who completed, in 1986, a comprehensive mailed questionnaire including information on usual intake of 127 food items. All cohort members were followed for cancer incidence through the statewide cancer registry. By 1991, after six years of follow-up, 272 incident lung-cancer cases were identified. After controlling for total energy intake and other confounding factors, dietary cholesterol, total fat, and animal fat were unrelated to lung cancer risk. Intake in the upper three quartiles of plantderived fat, however, was related to a 30 to 40 percent lower incidence of lung cancer, compared with those in the lowest quartile, with more pronoucned reduction in risk observed among smokers (relative risk=0.6, 95 percent confidence interval=0.4–0.9). This prospective cohort study suggests that high intake of fat of plant origin may be associated with reduced risk of lung cancer, while dietary cholesterol and animal fat intake is unrelated to the etiology of this malignancy in postmenopausal women.This study was supported by grant R01 CA 39742 of the US National Cancer Institute.     

云南锡矿工肺癌的队列研究

目的；建立矿工肺癌队列，探讨云锡矿工肺癌的危险因素，为肺癌早期标志物研究和肺癌防治研究提供基础。方法：以特殊人群为基础的前瞻性研究，每年用痰检和胸部X线对高危云锡矿工进行肺癌筛查，建立动态队列，分析氡、砷暴露等因素与肺癌的关系，并收集痰脱落细胞、胸片和其它生物样本。结果；1992－1999年间共有9143人进入队列，发现460例肺癌新病例，进行了47655人次胸部X线检查和46625人次痰检，年龄调整慢性支气管炎、硅肺和吸烟暴露RR分别为1．73、1．46和1．32。结论：成功建立了云锡职业暴露队列。作氡、砷暴露是该高危人群肺癌的危险因素外，慢性支气管炎、硅肺和吸烟也与肺癌发病有关。     

Diet and lung cancer mortality: a 1987 National Health Interview Survey cohort study

Objectives: To study the association between diet and lung cancer mortality in the United States. Methods: Records from 20,195 participants with usable dietary data in the 1987 National Health Interview Survey were linked to the National Death Index. Baseline diet was assessed with a 59-item food-frequency questionnaire. Food groups (fruits, vegetables, total meat/poultry/fish, red meats, processed meats, dairy products, breakfast cereals, other starches, added fats, and alcohol) were analyzed in cause-specific Cox proportional hazard regression models adjusted for age, gender and smoking. Results: There were 158 deaths from lung cancer (median follow-up 8.5 years). Frequencies of meat/poultry/fish intake (relative risk [RR] (highest compared to lowest quartile) = 2.0; 95% confidence interval [CI] 1.2–3.5, p for trend [p] < 0.027), and red meat intake (RR = 1.6; CI 1.0–2.6, p < 0.014), were positively and significantly associated with lung cancer mortality. Specifically, the red meats, including pork (RR = 1.6; CI 1.0–2.7, p < 0.028), and ground beef (RR = 2.0; CI 1.1–3.5, p < 0.096) were associated with increased risk, although for ground beef the trend was not significant. Dairy products (RR = 0.5; CI 0.3–0.8, p < 0.009) were inversely associated with lung cancer mortality. There was no statistically significant association between intake of fruits and vegetables and lung cancer mortality. Conclusions: In this nationally representative study, intake of red meats was positively associated with lung cancer mortality while intake of dairy products was inversely associated. While smoking is the major risk for lung cancer mortality, diet may have a contributory role.     

Neutrophil-to-lymphocyte ratio and risk of lung cancer mortality in a low-risk population: A cohort study

Neutrophil-to-lymphocyte ratio (NLR) is associated with poor prognosis in patients with lung cancer, but the predictive role of NLR on the risk of developing lung cancer is unknown. We investigated the association between NLR and lung cancer mortality in lung cancer-free adults. A cohort study was performed with 527,124 Korean adults who were free of lung cancer and were followed for up to 16 years. Vital status and lung cancer-related deaths were ascertained through national death records. Hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer mortality were estimated using a Cox proportional hazards model. During 4,567,495.8 person-years of follow-up, 574 lung cancer deaths were identified. A higher NLR was positively associated with lung cancer mortality. The multivariable-adjusted HR (95% CI) for lung cancer mortality comparing quintiles 2, 3, 4 and 5 of NLR to the lowest quintile were 1.26 (0.96–1.67), 1.23 (0.93–1.63), 1.33 (1.01–1.75) and 1.47 (1.13–1.92), respectively. The highest risk of lung cancer mortality was also observed in the highest NLR quintile among never-smokers and low-risk individuals after adjusting for lung function and other possible confounders. Platelet-to-lymphocyte ratio showed an inverse J-shaped association with lung cancer mortality in men but the trends in women, low-risk individuals or never-smokers were neither linear nor U-shaped. In this large cohort of young and middle-aged individuals, NLR was independently associated with increased risk of lung cancer mortality in low-risk individuals, indicating a role of systemic inflammation in lung cancer mortality in our study population.     

A cohort study of dietary carotenoids and lung cancer risk in women (Canada)

Objective: To investigate the association between dietary carotenoid intake and lung cancer risk in women. Methods: A case–cohort study was undertaken in the Canadian National Breast Screening Study dietary cohort, which consists of 56,837 women who completed a self-administered dietary questionnaire. The cohort was recruited between 1980 and 1985, and during follow-up to the end of 1993 a total of 196 cohort members were diagnosed with incident lung cancer. For analysis, a subcohort consisting of a random sample of 5681 women was selected from the full dietary cohort. After exclusions for various reasons, the analyses were based on 155 cases and 5361 non-cases. Results: When compared to those in the lowest quartile level of intake, the adjusted incidence rate ratios (95% confidence intervals) for those in the highest quartile levels of -carotene, -carotene, -cryptoxanthin, lycopene, and lutein intake were 0.90 (0.51–1.58), 1.40 (0.76–2.59), 0.66 (0.33–1.32), 1.04 (0.61–1.76), and 1.26 (0.70–2.24), respectively; none of the associated tests for trend was statistically significant. Conclusion: These results suggest that there is no association between dietary carotenoid intake and lung cancer risk, at least for the range of intakes observed here.     

Residential radon exposure, diet and lung cancer: a case-control study in a Mediterranean region

We performed a case-control study in Lazio, a region in central Italy characterized by high levels of indoor radon, Mediterranean climate and diet. Cases (384) and controls (404) aged 35-90 years were recruited in the hospital. Detailed information regarding smoking, diet and other risk factors were collected by direct interview. Residential history during the 30-year period ending 5 years before enrollment was ascertained. In each dwelling, radon detectors were placed in both the main bedroom and the living room for 2 consecutive 6-month periods. We computed odds ratios (ORs) and 95% confidence intervals (CIs) for time-weighted radon concentrations using both categorical and continuous unconditional logistic regression analysis and adjusting for smoking, diet and other variables. Radon measurements were available from 89% and 91% of the time period for cases and controls, respectively. The adjusted ORs were 1.30 (1.03-1.64), 1.48 (1.08-2.02), 1.49 (0.82-2.71) and 2.89 (0.45-18.6) for 50-99, 100-199, 200-399 and 400+ Bq/m(3), respectively, compared with 0-49 Bq/m(3) (OR = 1; 0.56-1.79). The excess odds ratio (EOR) per 100 Bq/m(3) was 0.14 (-0.11, 0.46) for all subjects, 0.24 (-0.09, 0.70) for subjects with complete radon measurements and 0.30 (-0.08, 0.82) for subjects who had lived in 1 or 2 dwellings. There was a tendency of higher risk estimates among subjects with low-medium consumption of dietary antioxidants (EOR = 0.32; -0.19, 1.16) and for adenocarcinoma, small cell and epidermoid cancers. This study indicates an association, although generally not statistically significant, between residential radon and lung cancer with both categorical and continuous analyses. Subjects with presumably lower uncertainty in the exposure assessment showed a higher risk. Dietary antioxidants may act as an effect modifier.     

Environmental tobacco smoke and lung cancer mortality in the American Cancer Society's Cancer Prevention Study II

Environmental tobacco smoke (ETS) has been classified as a human lung carcinogen by the United States Environmental Protection Agency (EPA), based both on the chemical similarity of sidestream and mainstream smoke and on slightly higher lung cancer risk in never-smokers whose spouses smoke compared with those married to nonsmokers. We evaluated the relation between ETS and lung cancer prospectively in the US, among 114,286 female and 19,549 male never-smokers, married to smokers, compared with about 77,000 female and 77,000 male never-smokers whose spouses did not smoke. Multivariate analyses, based on 247 lung cancer deaths, controlled for age, race, diet, and occupation. Dose-response analyses were restricted to 92,222 women whose husbands provided complete information on cigarette smoking and date of marriage. Lung cancer death rates, adjusted for other factors, were 20 percent higher among women whose husbands ever smoked during the current marriage than among those married to never-smokers (relative risk [RR]=1.2, 95 percent confidence interval [CI]=0.8-1.6). For never-smoking men whose wives smoked, the RR was 1.1 (CI=0.6-1.8). Risk among women was similar or higher when the husband continued to smoke (RR=1.2, CI=0.8-1.8), or smoked 40 or more cigarettes per day (RR=1.9, CI=1.0-3.6), but did not increase with years of marriage to a smoker. Most CIs included the null. Although generally not statistically significant, these results agree with the EPA summary estimate that spousal smoking increases lung cancer risk by about 20 percent in never-smoking women. Even large prospective studies have limited statistical power to measure precisely the risk from ETS.     

Diet diversity, diet composition, and risk of colon cancer (United States)

In this study, we evaluate diet diversity, diet composition, and risk of colon cancer in an incident population-based study of 1,993 cases and2,410 controls in the Kaiser Permanente Medical Care Program of Northern California, eight counties in Utah, and the Twin Cities area of Minnesota(United States). Ninety-one and one-half percent of the population were non-Hispanic White. Dietary intake was obtained using an adaptation of the CARDIA diet-history questionnaire. Diet diversity was defined as the number of unique food items reported; diversity also was explored within six major food groups. Composition of the diet was described by estimating the proportion of total number of food items contributed by major food groups. Younger individuals, higher educated individuals, and those who lived in larger households reported eating the most diverse diet. Total diet diversity was not associated with colon cancer. However, eating a diet with greater diversity of meats, poultry, fish, and eggs, was associated with a50 percent increase in risk among all men (95 percent confidence interval[CI] = 1.1-2.0; P trend = 0.01), with slightly stronger associations for younger men and men with distal tumors. A diet with a greater number of refined grain products also was associated with increased risk among men(odds ratio [OR] = 1.7, CI = 1.3-2.3). Women who ate a diet with a more diverse pattern of vegetables were at approximately a 20 percent lower risk than women who had the least diverse diet in vegetables. Assessment of diet composition showed that men who consumed a large proportion of their food items from meat, fish, poultry, and eggs were at an increased risk, with the most marked association being for distal tumors (OR = 1.7, CI = 1.2-2.5).Women who consumed the largest percentage of their food items in the form of plant foods (fruits, vegetables, or whole grains) were at a reduced risk of developing colon cancer (OR = 0.7, CI = 0.5-1.0). This revised version was published online in July 2006 with corrections to the Cover Date.     

陕西肺癌高发区宝鸡市肺癌危险因素研究

目的　探讨我国肺癌高发区之一陕西宝鸡市肺癌的危险因素。方法　采用病例 -对照研究。病例为宝鸡市 1 992～ 1 996年恶性肿瘤监测点登记的全部肺癌病人共 63例 ,按 1∶ 3比例配对选取 1 89例健康人为对照。共调查十类危险因素、78个问题。结果　单因素分析结果达到显著性水平的危险因素有吸烟、室内微环境污染、家庭经济状况、男性致癌物接触史 ;多因素分析结果基本一致。其中做饭取暖燃料种类 (液化气、蜂窝煤、烟煤 )、排气扇使用情况 (经常用、偶尔用、不用 ) ,年均收入存在明显趋势性 (趋势χ2检验 P <0 .0 5)。结论　除吸烟等其它因素外 ,宝鸡市肺癌与当地燃料种类及使用方式存在联系。     

Cohort mortality and nested case-control study of lung cancer among structural pest control workers in Florida (United States)

A previous report on the mortality of this cohort of Florida (United States) pest control workers found the risk of lung cancer was positively associated with the number of years licensed. An additional follow-up (1977–82) of this male cohort confirmed the excess (SMR=1.4) and the rising risk with increasing number of years licensed (SMR=2.2 among workers employed more than 20 years). A nested case-control study was undertaken to determine the effects of smoking and the type of pesticide exposure on lung cancer risk. Occupational histories and other data were obtained on 65 deceased lung cancer cases, 122 deceased controls, and 172 living controls. Interviews were conducted with next-of-kin regardless of the vital status of the subject. Odds ratios (OR) were adjusted by age and smoking. Adjustments for diet and other occupations had no effect on risk estimates and were not included in the final model. Using information from licensing records, ORs for lung cancer were greater for workers first licensed before age 40 (OR=2.4, 95 percent confidence interval [CI]=1.0–5.9 with deceased controls) and increased from 1.4 (CI=0.7–3.0) for subjects licensed 10–19 years to 2.1 (CI=0.8–5.5) for subjects licensed 20 or more years. Using living controls, an association with duration of employment was observed when years of licensure were lagged five years, but was not observed in unlagged analyses. Using information from the questionnaire, the risk of lung cancer was greater among those who worked as pest control operators than non-pest control workers. Although numbers were typically small, lung cancer risk among pest control operators was associated with reported exposure to carbamates, organophosphates, and phenoxyacetic acids and more specifically with diazinon, DDT, carbaryl, and propoxur. These results further suggest that pesticides may play a role in lung cancer risk and underscore the need for research that focuses on specific chemicals.     

A prospective study of cigarette tar yield and lung cancer

We examined the relationship of cigarette tar yield and other cigarette-usage characteristics in current smokers to the incidence of lung cancer in a study population of 79,946 Kaiser Permanente Medical Care Program members, aged 30–89 years, who completed a detailed, self-administered, smoking-habit questionnaire during the years 1979 through 1985. Mean length of follow-up was 5.6 years. There were 302 incident lung cancers, of which 89 percent occurred in current or former smokers. The tar yield of the current cigarette brand was unassociated with lung cancer incidence (relative risk [RR]=1.02 per 1 mg tar-yield in men, 95 percent confidence interval [CI]=0.98–1.05; RR=0.99, CI=0.96–1.03 in women). However, in long-term (>20 years) smokers, the risk of lung cancer was decreased in women who had smoked filtered cigarettes for 20 or more years relative to lifelong smokers of unfiltered cigarettes (RR=0.36, CI=0.18–0.75), but not in men who had smoked filtered cigarettes for 20 or more years (RR=1.04, CI=0.58–1.87).Authors are with the Division of Research, Kaiser Permanente Medical Care Program, 3451 Piedmont Avenue, Oakland, CA 94611, USA. Address correspondence to Dr Sidney. This study was funded by grants R01 CA 36074 and R35 CA 49761 from the US National Cancer Institute.     

A cohort study of smoking,alcohol consumption,and dietary factors for pancreatic cancer (United States)

Risk factors for pancreatic cancer were evaluated in a cohort study of 17,633 White men in the United States who responded to a mailed questionnaire in 1966 and were followed-up through 1986 for mortality. Cigarette smoking and alcohol consumption were found to be important risk factors for pancreatic cancer. Risks increased significantly with number of cigarettes smoked, reaching fourfold for smokers of 25 or more cigarettes per day relative to nonsmokers. Alcohol intake also was related significantly to risk, with consumers of 10 or more drinks per month having three times the risk of nondrinkers, but dose-response trends among drinkers were not smooth. Coffee consumption was unrelated to risk. Dietaryanalyses revealed a rising rate of pancreatic cancer mortality with increasing consumption of meat after adjustment for other risk factors. Men in the highest quartile of meat intake had about three times the risk of those in the lowest quartile. No consistent association, however, was observed for consumption of fruits, vegetables, or grains. This study confirms cigarette smoking as an important risk factor for pancreatic cancer, and provides evidence that elevated intake of alcohol and meat may increase the risk of this fatal malignancy.Drs Zheng (at the time of this study), McLaughlin, Gridley, Silverman, Wacholder, Blot, and Fraumeni Jr. are with the Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD, USA. Dr Zheng is currently with the School of Public Health, University of Minnesota, Minneapolis, MN, USA, as is Dr Schuman. Dr Bjelke is with the Center for Epidemiologic Research, University of Bergen, Bergen, Norway. Mr Co-Chien is with Westat, Inc., Rockville, MD, USA. Address correspondence to Dr McLaughlin, Biostatistics Branch, National Cancer Institute, 6130 Executive Blvd., Room 415, Bethesda, MD 20892, USA.     

Nutrients and pancreatic cancer: a population-based case-control study

A case-control study was conducted in the Minneapolis-St Paul (Minnesota, United States) area to assess the role of dietary factors in the etiology of pancreatic cancer. Cases were White males aged 40 to 84 whose death certificate listed pancreatic cancer (exocrine only). White male controls were ascertained through random-digit dialing. Family members were interviewed about the subject's dietary usage in the two years prior to death (cases, n=212) or prior to interview (controls, n=220). Energy-adjusted,nutrient-intake, risk estimates were calculated. Among all respondents, negative trends were observed for polyunsaturated fat, linoleic acid, vitamin C, and -carotene. Positive trends were observed for riboflavin and retinol. Point estimates were, in general, comparable between the analyses of all respondents and spouse-only respondents. The nutrients associated with a decreased risk for pancreatic cancer occur primarily in vegetables and fruits, of which the consumption of cruciferous and -carotene-rich vegetables and citrus fruits provided the greatest reduction in risk.Authors are at the University of Minnesota. Drs Olsen and Schuman are at the School of Public Health, Division of Epidemiology, Minneapolis, MN, USA. Dr Mandel is with the Division of Environmental and Occupational Health, School of Public Health. Dr Gibson is at the School of Medicine, Department of Behavioral Sciences. Dr Wattenberg is at the School of Medicine, Department of Laboratory Medicine and Pathology. Address correspondence to Dr Olsen, The Dow Chemical Company, Health and Environmental Sciences, Epidemiology, 1803 Building, Midland, MI 48674, USA. This study was supported by grant SIG5 from the American Cancer Society.     

Retrospective cohort study of risk-factors for esophageal cancer in Linxian,People's Republic of China

A retrospective cohort study of esophageal (including gastric cardia) cancer was conducted to examine dietary and other potential risk factors in Linxian, a high-risk area in P.R. China. Study subjects were identified based on participation in a cytology examination conducted in 1974. They were interviewed in 1989 to obtain information on esophageal cancer risk-factors and identify new cases and deaths. A total of 1,162 subjects from the analytic cohort of 12,693 were determined to have developed esophageal cancer over the 15-year follow-up period. Results indicate that increased age, male gender, a positive family history, low education level, surface-water use, and pork consumption were the strongest risk factors for esophageal cancer identified in this cohort, while use of corn as a primary staple and infrequent consumption of fresh vegetables also were possible risk factors. Traditional or suspected risk factors for esophageal cancer in this and other populations—smoking and alcohol use, and pickled vegetable and moldy food consumption—were not risk factors in this study. Some variation in risk was seen based on the subject's cytology result from 1974. We conclude that dietary factors appear to play a role in the etiology of esophageal cancer in this high-risk population, but are less important than other constitutional factors such as age, gender, and family history.Drs Yu, Li, Wang, Guo, Wang, Liu, and Li are with the Cancer Institute of the Chinese Academy of Medicinal Sciences in Beijing, PRC. Drs Taylor, Dawsey, and Blot are with the National Cancer Institute in Bethesda, MD, USA. Dr Shen is with Henan Medical University in Zhengzhou, PRC. This project was funded partially by contract # NO1-CP-41019 from the US National Cancer Institute.     

Mediterranean diet adherence and risk of postmenopausal breast cancer: results of a cohort study and meta‐analysis

The Mediterranean Diet (MD) has been associated with reduced mortality and risk of cardiovascular diseases, but there is only limited evidence on cancer. We investigated the relationship between adherence to MD and risk of postmenopausal breast cancer (and estrogen/progesterone receptor subtypes, ER/PR). In the Netherlands Cohort Study, 62,573 women aged 55–69 years provided information on dietary and lifestyle habits in 1986. Follow‐up for cancer incidence until 2007 (20.3 years) consisted of record linkages with the Netherlands Cancer Registry and the Dutch Pathology Registry PALGA. Adherence to MD was estimated through the alternate Mediterranean Diet Score excluding alcohol. Multivariate case–cohort analyses were based on 2,321 incident breast cancer cases and 1,665 subcohort members with complete data on diet and potential confounders. We also conducted meta‐analyses of our results with those of other published cohort studies. We found a statistically significant inverse association between MD adherence and risk of ER negative (ER?) breast cancer, with a hazard ratio of 0.60 (95% Confidence Interval, 0.39–0.93) for high versus low MD adherence (p _trend = 0.032). MD adherence showed only nonsignificant weak inverse associations with ER positive (ER+) or total breast cancer risk. In meta‐analyses, summary HRs for high versus low MD adherence were 0.94 for total postmenopausal breast cancer, 0.98 for ER+, 0.73 for ER? and 0.77 for ER ? PR? breast cancer. Our findings support an inverse association between MD adherence and, particularly, receptor negative breast cancer. This may have important implications for prevention because of the poorer prognosis of these breast cancer subtypes.     

Dietary associations in a case-control study of endometrial cancer

Despite the established role of obesity in the etiology of endometrial cancer, limited data are available from analytical epidemiologic studies on the association of risk with dietary factors. A case-control study of 399 cases and 296 controls conducted in five areas of the United States from 1 June 1987 to 15 May 1990, enabled evaluation of risk related to dietary intakes adjusted for potential confounders. Caloric intake was associated modestly with increased risk (odds ratio [OR]=1.5,95 percent confidence interval [CI]=0.9–2.5 for highest cf lowest quartiles of intake), with the principal contributors being fat and protein calories. After adjustment for other risk factors, including body mass, increased risk was associated with higher intakes of fat. Several components of fat investigated were associated with increased risk, although associations were slightly stronger for saturated fat (OR=2.1, CI=1.2–3.7) and oleic acid (OR=2.2, CI=1.2–4.0) than for linoleic acid (OR=1.6, CI=0.9–2.8). Food-group analyses showed intake of complex carbohydrates—and specifically of breads and cereals—associated with reduced risks (OR=0.6, CI=0.4–1.1), whereas animal fat and fried foods were associated with elevated risks (OR=1.5 and 1.7, respectively). The relations of endometrial cancer with animal fat and complex carbohydrates were independent. No consistent associations were noted for intakes of cholesterol, fiber, vitamins A and C, individual carotenoids, or folate-rich foods. These data imply an etiologic role for a diet rich in total fat and/or animal fat and low in complex carbohydrates with endometrial cancer. These associations are consistent with a hormonal mechanism and were independent of the associations of obesity and other risk factors.Drs Potischman, Swanson, Brinton, and Hoover are with the Environmental Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA. Authors are also affiliated with Information Management Services, Inc., Silver Spring, MD (Ms McAdams), and the Departments of Obstetrics and Gynecology at Bowman Gray School of Medicine, Winston-Salem, NC (Dr Barrett); University of California at Irvine Medical Center, Irvine, CA (Dr Berman); Milton S. Hershey Medical Center, Hershey, PA (Dr Mortel); University of Minnesota Medical School, Minneapolis, MN (Dr Twiggs); Rush Medical College, Chicago, IL (Dr Wilbanks). Address correspondence to Dr Potischman, Nutritional Epidemiology Section, Division of Cancer Etiology, National Cancer Institute, Executive Plaza North, Suite 443, Bethesda, MD 20892, USA.     

Cancer mortality in German male workers exposed to phenoxy herbicides and dioxins

In an occupational cohort study, the relation between exposure to phenoxy herbicides, and contaminants (dioxins and furans) and cancer mortality was investigated. A total of 2,479 workers from four plants in Germany were included, with a mortality follow-up until the end of 1989 (for one cohort, until the end of 1992). A total of 484 deaths were recorded yielding a standardized mortality ratio (SMR) of 101 (95 percent confidence interval [CI]=92–111) for total mortality, and an SMR of 119 (CI=100–141) for all malignant diseases. A variety of herbicides was produced, including those which are known to have been contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). High dioxin and furan exposure (in particular, exposure to TCDD, but also to higher chlorinated dioxins) had occurred in two of the four plants as shown by blood-fat measurements in a sample of workers. Mortality from all neoplasms increased with latency and was highest in the largest plant where the highest TCDD blood levels were recorded. An increased mortality in the total cohort from respiratory cancer (SMR=154, CI=115–202), cancer of the buccal cavity and pharynx (SMR=295, CI=135–560), and non-Hodgkin's lymphoma (SMR=326, CI=119–710) was observed. Our findings are consistent with results from other cohorts which showed an increased overall cancer mortality and mortality of respiratory cancer after long-term exposure to these phenoxy herbicides and dioxins.Drs Becher, Steindorf, and Wahrendorf are with the German Cancer Research Center, Heidelberg, Germany; Drs Flesch-Janys and many are with the Medical Center for Chemical Workers' Health, Hamburg, Germany; Dr Kauppinen is with the Finnish Institute of Occupational Health, Helsinki, Finland; Dr Kogevinas is with the International Agency for Research on Cancer, Lyon, France, and Institut Municipal D'investigacio Medica, Barcelona, Spain. Address correspondence to Dr Becher, German Cancer Research Center, Division of Epidemiology, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany. This study was supported by the German Ministry of Research and Technology under contract 01HK 5283.     

Occupation and bladder cancer: a cohort study in Sweden

In a follow-up study of occupational exposures and bladder cancer, an increased risk was observed after an adjustment for smoking, for physicians, administrators and managers, clerical workers and sales agents among men and assistant nurses among women. For physicians, the reason may be early diagnosis; for the other groups a sedentary type of work may have a role in bladder cancer aetiology.     

Risk of urinary bladder cancer among Blacks and Whites: the role of cigarette use and occupation

A case-control study was conducted in the United States to examine the relationship between urinary bladder cancer, usual occupation and industry, and cigarette smoking. A total of 2,160 bladder cancer cases and 3,979 colon and rectum comparison cases, with complete histories of occupation and tobacco use, were included in the analysis. Ever having smoked cigarettes significantly elevated bladder cancer risk (odds ratio = 2.4). A dose-response relationship was demonstrated between bladder cancer and pack-years of smoking, usual number of cigarettes smoked per day, and number of years having smoked. This study observes greater risk of urinary bladder cancer due to cigarette smoking among Black males and females than among White males and females. A significant excess of bladder cancer was found among armed services personnel; this excess was restricted to White males when the analysis was performed separately by race. Black males with mechanic as their usual occupation had a significant sevenfold excess of bladder cancer. The population attributable risks for occupation and smoking were 25 percent and 51 percent, respectively. The results demonstrate the strength of the association between cigarette smoking and bladder cancer and the need to control for smoking in occupational analyses.Authors are in the College of Human Medicine, Michigan State University. Address correspondence to Dr G. Marie Swanson, Professor of Medicine, College of Human Medicine, Michigan State University, A-211 East Fee Hall, East Lansing, MI 48824-1316, USA. This study was supported in part by grant RO1-OHO2067 from the National Institute for Occupational Safety and Health and by contract NO1-CN-05225 from the National Cancer Institute.