Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease.

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.

Characteristics of atrophic rhinitis in Thai patients at the Siriraj Hospital.

The common characteristics of primary atrophic rhinitis were studied in 46 Thai patients. From history and demographic data the female to male ratio was found to be 5.6 to 1. The significance of environmental factors was supported by the findings that 69.6% were people from rural areas and 43.5% were industrial workers but a hereditary factor has not been confirmed. The results of the blood tests did not elucidate iron deficiency anemia or nutritional deficiency as the cause of primary atrophic rhinitis. However, all nasal swab cultures yielded pathogenic organisms where Klebsiella species especially, K. ozaena, were the most common bacteria isolated which were 100% susceptible to cephalosporins. This finding together with the evidence of sinusitis seen in 58.7% of either plain x-rays or CT scans, was suggestive of the important role of infection in atrophic rhinitis. Atrophic change of the mucosa and bone with widening of the nasal cavity were constant findings in the CT scans but the developmental anomaly of the maxillary antrum was found in only 15.2%. The histological study showed characteristic changes especially squamous metaplasia and 80% of the cases were compatible with the Type II histopathological classification, i.e. vasodilatation of the capillaries. The mucociliary function was proven to be impaired in accordance with the loss of cilia. The evidence of Type I allergy demonstrated by skin testing, which was obvious in 85%, is highly suggestive of allergic/immunologic disorders. Although many factors have been cited previously as the possible cause of primary atrophic rhinitis, the common characteristics found in our patients indicate that only bacterial infection, environmental factors and allergic/immunologic disorders could be one or more of its multifactorial etiology and should be further investigated.

Detection of Epstein-Barr virus DNA and HHV-6 DNA in tissue biopsies from patients with nasopharyngeal carcinoma by polymerase chain reaction.

A total of 34 tissue biopsies were collected from nasopharyngeal carcinoma (NPC) patients and 5 controls with non-NPC. Extracted DNA from tissue biopsies were analyzed for presence of specific gene sequences to EBV type A and type B, and HHV-6 by polymerase chain reaction (PCR). The different sequences of EBV type A and B were parts from the highly divergent forms of the EBV nuclear antigen 2 (EBNA 2). The PCR amplified products for EBNA 2A and EBNA 2B were 115 and 119 base pairs respectively whereas that of HHV-6 DNA was 776 base pairs. The results demonstrated that EBV DNA was detected in 32 of 34 cases (94.1%): 28 (82.3%) with type A, 2 (5.9%) with type B, and 2 (5.9%) with both types. EBV DNA of type A could be detected 1 (20%) of 5 controls. HHV-6 DNA was in 5 of 34 samples (14.7%) whereas HHV-6 DNA was not detectable in biopsy tissues from controls. The results show that in the NPC patient group, A type of EBV is predominant. Detection of HHV-6 DNA in patients group only might be resulted from reactivation of a latent infection or association with EBV-induction of NPC.

Prevalence of IgA specific antibodies to Epstein-Barr virus capsid and early antigens in nasopharyngeal carcinoma.

Ninety-one patients with nasopharyngeal carcinoma (NPC), and 164 age-matched healthy controls were tested for presence of IgA antibodies to Epstein-Barr virus capsid antigen (VCA) and early antigen (EA) in their sera by indirect ELISA using "EBViral DETECT" commercial test kit. IgA anti-VCA was found in 76 (83.5%) of NPC patients and 16 (9.8%) of the controls. Meanwhile, IgA anti-EA was found in 72 (79.1%) of NPC patients and 21 (12.8%) of the controls. In a parallel study by indirect immunofluorescence test (IIF), IgA anti-VCA was found in 77 of 91 (84.6%) NPC patients and 22 of 142 (15.5%) controls. The prevalence rates of anti-VCA as screened by ELISA and IIF were very similar suggesting that neither one of the two tests can be used alternatively depending on the purpose and facilities in each individual laboratory. IgA antibodies to VCA and EA were more prevalence in NPC patients than those in the controls, the finding which again supported the association between EBV and NPC as was suggested in many other reports.

Epstein-Barr virus serological markers for nasopharyngeal carcinoma in Thailand.

The present study reports on the prevalence of specific IgA and IgG antibodies to EBV viral capsid antigen in nasopharyngeal carcinoma (NPC) patients with different histological types of carcinoma and their age-matched controls by the indirect immunofluorescence test, using the B-95-8 lymphoblastoid cell line as source of viral capsid antigen. EBV specific IgG was found in almost all the study cases, and antibody titers were significantly higher in the NPC patients than in non-cancer controls. GMT of anti-EBV IgG in NPC patients, patients with other malignant diseases, and those with non-malignant diseases were 371.5, 97.7 and 35.5, respectively. Anti-EBV specific IgA was more specific to NPC than was IgG, and was present in 86.5% (83 of 96) cases of NPC patients, 6.6% (2 of 30) of patients with other cancers, and 3.1% (3 of 97) cases of non-malignant diseases. A weak correlation between level of anti-EBV IgA in NPC patients was observed (r = 0.3). EBV IgA was found in all histological types of NPC, ie, WHO types 1, 2 and 3, but WHO type 1 was rare among NPC patients in Thailand. Use of anti-EBV IgA for monitoring cancer therapy is to be further investigated.

Mitoxantrone as single agent in the treatment of advanced breast cancer: clinical experience at Siriraj Hospital.

A total of 35 patients with advanced breast cancer were treated with mitoxantrone, 14 mg/m2 I.V. every 3 weeks. Of these, 27 patients or 78 lesions could be evaluated for response and all 35 patients for toxicity. The overall response rate (CR + PR) was 35 per cent (or CR + PR + SD = 82%), ten lesions achieved a complete response and 17 lesions a partial response. The duration of response varied from a minimum of 2 months to more than 11 months (median = 4 months). Myelosuppression was the dose-limiting toxicity with moderate to severe degree in 19 patients. The most frequent severe degree in 19 patients. The most frequent non-hematologic toxicity was mild grade of nausea and vomiting (67%). No cardiotoxicity was noted in this study after the maximum cumulative dose of mitoxantrone 157.5 mg.

Visceral leishmaniasis: a case report.

Visceral leishmaniasis is diagnosed in a Thai worker returning home from the Middle East. A 39-year-old Thai male who had abdominal swelling, weight loss, hepatosplenomegaly and hyperglobulinemia, was diagnosed by demonstration of organism in liver biopsy and bone marrow aspiration specimen. Amphotericin B was administered in this case.