Lymphatic vessel density is significantly increased in melanoma.

BACKGROUND: Melanoma is well known for its ability to involve regional lymph nodes in the early stage. However, the presence of lymphangiogenesis in melanoma is still controversial due to lack of lymphatic-specific markers. The purpose of this study was to determine the intra- and peritumoral lymphatic vessel density (LVD) using a novel lymphatic vessel-specific marker D2-40 and compare it to general vessel density (GVD) as determined by CD31 immunostaining in a series of melanocytic lesions. METHODS: The intra- and peritumoral GVD and LVD were examined by immunohistochemistry using D2-40 and CD31 antibodies in a series of melanocytic lesions. RESULTS: We found significantly higher intratumoral LVD in melanomas as compared to either common acquired or dysplastic nevi (p < 0.01). Although peritumoral LVD in melanoma and malignant melanoma in situ was higher compared to nevi, the difference did not reach statistical significance (p = 0.059). There was no significant difference in GVD among the various groups of melanocytic lesions. CONCLUSIONS: Our results show that intratumoral LVD is significantly increased in melanomas compared to benign nevi. The higher intratumoral lymphatic density in invasive melanomas suggests that melanoma cells might promote lymphangiogenesis. In addition, assessment of intratumoral LVD may be potentially useful in the differential diagnosis of melanocytic lesions.

Sun protection practices in preadolescents and adolescents: a school-based survey of almost 25,000 Connecticut schoolchildren.

Sun protection practices in children and adolescents fall well below national recommendations. We present the results of a survey of sun protection use and other health-related behaviors in a sample of Connecticut Caucasian students aged 9 through 18 years (N = 24,645). Our objectives were to estimate the prevalence of sun protection use and to evaluate the relationship between sun protection use and health-risk behaviors and attitudes about appearance. We present data from 1988 through 1995 from the Connecticut Health Check, a health risk appraisal survey sponsored by the Connecticut Department of Public Health. Students enrolled in public and private elementary junior as well as senior high schools took the self-administered anonymous survey, which included multiple-choice questions about use of sun protection, cigarettes, and alcohol and about body image and self-esteem. We report prevalence proportions for use of sun protection by demographic features. We compared the proportion of students in 3 categories of outcome (always, sometimes, and never use sun protection) who reported various health-risk behaviors. Twenty percent of the sample reported always using sun protection; this is well below national goals set forth in the Healthy People 2000 recommendations. Sun protection use was inversely related to age and was higher among girls than boys at all ages. At all ages, students who did not use sun protection were more likely than those who did to report other health risk behaviors, such as use of cigarettes and alcohol. The data suggested that use of sun protection is associated with positive attitudes about appearance and self-image. Use of sun protection may be one component of an overall mode of health awareness and behavior. Programs promoting safe sun practices should target boys and be integrated into an overall campaign aimed at other risk-taking behaviors.

Risk of ovarian cancer according to use of antidepressants, phenothiazines, and benzodiazepines (United States).

OBJECTIVES: An association of increased risk of ovarian cancer with use of antidepressants or benzodiazepine tranquilizers has been reported from a case-control study. We assessed the association between ovarian cancer risk and the use of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), phenothiazine antipsychotics, and benzodiazepines, in data from the Case-Control Surveillance Study. METHODS: From 1976 through 1998, data were collected from hospital patients in Boston, New York, Philadelphia, and Baltimore based on demographic factors, reproductive and medical history, and medication use. In the present analyses, cases of epithelial ovarian cancer (n = 748) were compared with cancer controls (n = 1496) and noncancer controls admitted for trauma and acute infection (n = 1496). We estimated Mantel-Haenszel odds ratios adjusted for age, study center, and year of interview. RESULTS: Odds ratios for regular use (at least 4 days/week for at least 1 month) were compatible with 1.0 for every drug class. For tricyclics and benzodiazepines the upper 95% confidence limits were less than 1.6. For phenothiazines the upper limit was 2.6 with cancer controls and 1.4 with noncancer controls. Only five cases used SSRIs, yielding unstable results. Odds ratios were not increased among women who had used any drug class for at least 5 years, nor among women who had first used them 10 or more years previously. CONCLUSIONS: These data do not support an association between regular use of any of the drugs under study with ovarian cancer risk.

A case-control study of analgesic use and ovarian cancer.

A recent case-control study raised the hypothesis that acetaminophen use 1 day or more per week for at least 6 months reduces the risk of epithelial ovarian cancer. We assessed analgesic use in relation to epithelial ovarian cancer risk using data from our case-control surveillance study of medication use and cancer. Patients were interviewed in hospitals in Baltimore, Boston, New York, and Philadelphia during 1976-1998. We compared 780 women with epithelial ovarian cancer to 2053 cancer controls and 2570 noncancer controls. For acetaminophen use 1 day or more per week for at least 6 months, the odds ratio estimate was 0.9 (95% confidence interval, 0.6-1.4) derived with cancer controls and 1.0 (0.6-1.5) with noncancer controls. Estimates for more frequent and longer term use were also compatible with 1.0. The odds ratios among patients with metastatic ovarian cancer were reduced but not statistically significant. The odds ratio for use of nonsteroidal anti-inflammatory drugs 4 or more days per week for at least 5 years, 0.5, was statistically significant. The present results provide only weak support for a reduction in the risk of epithelial ovarian cancer among acetaminophen users. They raise the possibility of an inverse association with long-term nonsteroidal anti-inflammatory drug use.

Prevalence and correlates of smokeless tobacco use in a sample of Connecticut students.

We examined the prevalence of smokeless tobacco use, and its relationship to other risky behaviors in Connecticut school children in grades four through 12 (n=31,861). Less than one per cent of students in grades 4-8, and four per cent of those in grades 9-12, used smokeless tobacco. Eighty-two percent of all users were white males. Among high school males, the prevalences of risk-taking behaviors and feelings of stress and depression were significantly higher among users than non-users. Among high school males, the highest prevalences of risky behaviors and stress indicators were reported by joint users of cigarettes and smokeless tobacco.

NSAIDs and risk of colorectal cancer according to presence or absence of family history of the disease.

BACKGROUND: We undertook the present analyses to determine whether family history of colorectal cancer in a parent or sibling modifies the inverse association of nonsteroidal anti-inflammatory drug (NSAID) use with colorectal cancer risk. METHODS: We used data from two case-control studies of colorectal cancer. The hospital-based Case Control Surveillance Study included 1526 patients with primary colorectal cancer, 4192 cancer controls and 6036 noncancer controls. A population-based study conducted in Massachusetts enrolled 1201 incident cases of colorectal cancer and 1201 community controls. Data on NSAID use and risk factors for colorectal cancer were collected by interview. RESULTS: In both studies there was a reduction in the odds ratios among subjects who used NSAIDs regularly continuing into the previous year, regardless of family history. In the Case Control Surveillance data, the odds ratio was 0.4 (95% CI 0.2-0.9) among subjects with a family history and 0.5 (95% CI 0.4-0.7) among subjects without a family history. The comparable odds ratios in the Massachusetts data were 0.5 (95% CI 0.3-0.9) and 0.7 (95% CI 0.6-0.9). CONCLUSIONS: These data indicate that regular continuing NSAID use is associated with a reduced risk of colorectal cancer among persons with a family history of the disease, as well as those without such a history.

Nonsteroidal anti-inflammatory drugs and risk of digestive cancers at sites other than the large bowel.

Regular continuing nonsteroidal anti-inflammatory drug (NSAID) use has been associated with a reduction in risk of large bowel cancer in many studies, including our Case-Control Surveillance Study of medication use and cancer risk. We assessed the relation of NSAID use to the risk of digestive cancers at sites other than the large bowel in this database. Nurse-interviewers administered questionnaires to patients admitted to hospitals in four centers from 1977 to 1998. Cases comprised 1149 patients with cancers of the pancreas (n = 504), stomach (n = 254), esophagus (n = 215), gallbladder (n = 125), or liver (n = 51). Controls were 5952 patients admitted for trauma or acute infection. History of NSAID use was elicited by questions about indications for use. Multiple logistic regression models were used to calculate odds ratios (ORs) for categories of regular NSAID use (at least 4 days/week for at least 3 months) relative to never use. The OR for regular use initiated at least 1 year before admission and continuing into that year was reduced for stomach cancer (OR = 0.3; 95% confidence interval, 0.1-0.6) and was compatible with 1.0 for other sites. The ORs for regular continuing use of at least 5 years duration were < 1.0 for cancers of the stomach, pancreas, esophagus, and gallbladder but were statistically significant only for stomach cancer. These data suggest that regular continuing NSAID use may be associated with reduced risk of stomach cancer. For the other sites, the data are consistent with no effect of NSAID use.

Lactation and breast carcinoma risk in a South African population.

BACKGROUND: A number of epidemiologic studies have reported a reduced risk of breast carcinoma among women who have lactated but others have not. The current study presents data regarding lactation and breast carcinoma risk from a hospital-based case-control study of black and colored South African women. METHODS: Incident breast carcinoma cases treated between January 1994 and October 1997 (n = 446) at 2 major hospitals in Cape Town and hospital patients admitted for conditions unrelated to breast carcinoma (controls, n = 1471) were queried regarding the duration of breast-feeding each liveborn child and breast carcinoma risk factors. Multivariate logistic regression models were used to calculate odds ratios (ORs) for various categories of lactation compared with a reference category of never having breast-fed among women who had had at least one full term live birth. RESULTS: Approximately 83% of cases and 85% of controls had ever breast-fed (OR = 0.9; 95% confidence interval [95% CI], 0.7-1.3). Among all subjects, the ORs for those who lactated for <3 years were near or at unity. Beyond 3 years, ORs extending up to >/=7 years were less than unity, but the 95% CIs included 1.0 (OR for duration of >/=7 years = 0.7; 95% CI, 0.4-1.3). ORs did not vary by menopausal status. Breast carcinoma risk was not found to be related to the duration of breast-feeding the first child, the number of children breast-fed, or the patient's age at first lactation. CONCLUSIONS: The results of the current study suggest lactation has little or no protective effect on breast carcinoma risk.

The relationship of nonsteroidal anti-inflammatory drug use to the risk of breast cancer.

BACKGROUND: The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the risk of breast cancer is unclear. We assessed the association in a hospital-based case-control study. METHODS: The cases (n = 6558) were compared with cancer controls (n = 3296) and noncancer controls admitted for trauma or acute infection (n = 2925). Odds ratios were estimated using multivariate logistic regression models. RESULTS: For women who used NSAIDs regularly beginning at least 1 year before admission, the odds ratios (OR) were 0.8 (95% CI 0.7, 1.0) with cancer controls and 0.7 (95% CI 0.6, 0.9) with noncancer controls. With noncancer controls, there was a statistically significant decreasing trend in the odds ratios as duration of use increased, whereas with cancer controls there was not. The reduction in risk for regular use was accounted for largely by a reduced odds ratio for one study center (Boston), which contributed 9% of the cases. CONCLUSIONS: The data are compatible with a small reduction in risk associated with regular NSAID use. However, inconsistencies in the data detract from a causal interpretation.

Occupational physical activity and breast cancer risk in the upper Cape Cod cancer incidence study.

BACKGROUND: In several epidemiological studies, breast cancer risk has been reduced among women who reported high levels of occupational or leisure-time physical activity. We used data from a population-based case control study to evaluate the effect of occupational physical activity on breast cancer risk. METHODS: Two hundred-thirty three incident cases of breast cancer and 670 controls or their next of kin were interviewed for information on breast cancer risk factors and a complete job history. Physical activity level of jobs were classified using a Department of Labor rating scheme. We calculated adjusted odds ratios for light and medium/heavy activity jobs compared to sedentary jobs. RESULTS: Odds ratios for women who held medium/heavy jobs for less than 10 years and more than ten years were, respectively, 0.7 (95% CI = 0.4,1.3) and 1.7 (95% CI = 0.9,3.3). CONCLUSIONS: In these data there was no evidence that holding a job of medium/heavy activity reduced breast cancer risk. The study was limited by misclassification inherent in the occupational exposure scheme and by the lack of information on leisure time physical activity. The modest risk increase for subjects holding a medium/heavy job for at least 10 years probably represents either confounding or random variation.

Leukemia in petroleum refinery workers: a review of recent studies.

A previous review of the published epidemiologic literature on cancer risk in workers in the petrochemical industry indicated excess risks of leukemia and several other cancers. Here we update this review, focusing on the risk of hematologic cancers (for example, leukemia and lymphoma) reported in studies of oil refinery workers published in the last ten years. Limitations of recent studies are discussed, including the dilution of highly exposed groups of workers with workers with little or no exposure. We consider the evidence for a "safe level" or threshold of benzene exposure in the light of its ability to cause several types of damage, including damage to stem cells which may cause a variety of malignancies. We conclude that there is evidence of a slight increase in mortality from leukemia among oil refinery workers, particularly among those employed before 1950. And continuing exposures to benzene and other carcinogens occurring in this industry should be controlled.

Exposure to power frequency magnetic fields and risk of breast cancer in the Upper Cape Cod Cancer Incidence Study.

Investigators used a population-based case-control study to evaluate the relationship between breast cancer risk and exposure to 60-Hz magnetic fields from various sources. There was no increase in breast cancer risk associated with (a) holding a job with high (odds ratio [OR] = 1.2; 95% confidence interval [CI] = 0.4, 3.4) or medium (OR = 0.9; 95% CI = 0.5, 1.7) exposure to magnetic fields; (b) living in a home heated electrically (OR = 1.0; 95% CI = 0.7, 1.4); or (c) sleeping with an electric blanket (OR = 1.0; 95% CI = 0.7, 1.4). There was a nonsignificant 50% increase in risk for subjects who lived within 152 m (500 ft) of an electricity transmission line or substation (OR = 1.5; 95% CI = 0.6, 3.3). Although limited by small numbers and exposure misclassification, the data in this study did not support the hypothesis that exposure to 60-Hz magnetic fields increases the risk of breast cancer in women.

Factors associated with smoking among children and adolescents in Connecticut.

INTRODUCTION: The age of smoking initiation has dropped over the past four decades. Since behaviors and attitudes adopted in late childhood or early adolescence predict future smoking, it is important to understand the smoking and other risk-taking behaviors and attitudes of children aged 12 and younger. The goal of the analyses presented here was to describe behavioral and attitudinal factors associated with smoking among elementary school (grades 4-6), middle school (grade 7-8), and high school (grades 9-12) students in Connecticut. METHODS: We have used data from 8 years (1988-1996) of an anonymous, self-administered health risk appraisal survey given to children and adolescents in self-selected public and private schools. We compared the proportion of smokers and nonsmokers who reported various behaviors and attitudes and compared them with the chi-square test. RESULTS: Fifteen percent (n = 4,884) of the total population (n = 31, 861) were current smokers. At all grade levels, current smokers were more likely than nonsmokers to engage in risk-taking behaviors, and to report more stress and depression. Indicators of risk-taking and stress were also associated with the intent to smoke among children in grades 4-6. CONCLUSIONS: Smoking occurs within the context of other risk-taking behavior and psychological distress, among both children and older adolescents. Our data provide support for the idea of early identification and targeting of children at high risk of smoking in elementary school, possibly as early as grade four.

Occupational exposure to estrogenic chemicals and the occurrence of breast cancer: an exploratory analysis.

BACKGROUND: We conducted a population-based case-control study to describe the relationship between occupational exposure to estrogenic chemicals and the occurrence of breast cancer in Cape Cod, Massachusetts. METHODS: Incident cases of breast cancer (n = 261) diagnosed from 1983 through 1986 and controls (n = 753) were interviewed to gather information on breast cancer risk factors and all full-time jobs held since age 18. Blinded exposure assessments were employed using the data from the NIOSH National Occupational Exposure Survey, chemical production and usage information, and the expert judgement of a certified industrial hygienist. RESULTS: Overall, 29.5% of cases and 32.5% of controls had probable occupational exposure to one or more xenoestrogens. Probable exposure to nonylphenol (21.5% of cases, 21.4% of controls), butyl benzyl phthalate (10.0% of cases, 13.2% of controls), BHA (7.3% of cases, 9.6% of controls), bisphenol A (9.6% of cases, 11.6% of controls), and 4-tert-butylphenol (2.7% of cases and 5.3% of controls) were relatively commons, while probable exposure to the other xenestrogens was rare. Only PCBs and 4-octylphenol were associated with moderate increase in the odds of breast cancer (PCBs: 5 exposed cases and 6 exposed controls, adjust odds ratio: 3.2, 95% CI = 0.8-12.2, and 4-octylphenol: 6 exposed cases and 5 exposed controls, adjusted odds ratio: 2.9, 95% CI = 10.8).

Physical activity in usual occupation and risk of breast cancer (United States).

We have used data from a large population-based case-control study in the United States to evaluate the effect of occupational physical activity on breast cancer risk. Women diagnosed with breast cancer identified from four state cancer registries, and controls randomly selected from lists of licensed drivers or Medicare beneficiaries, were interviewed by telephone for information on usual occupation and other factors. We classified usual occupation into one of four categories of physical activity. After excluding subjects for whom a strength rating could not be assigned, we had a final sample size of 4,863 cases and 6,783 controls. Using conditional logistic regression models, we calculated adjusted odds ratios (OR) and 95 percent confidence intervals (CI) for occupations having light, medium, and heavy activity compared with sedentary ones. Women with heavy-activity occupations had a lower risk of breast cancer than women with sedentary jobs (OR = 0.82, CI = 0.63-1.08), as did women with jobs with medium activity (OR = 0.86, CI = 0.77-0.97) or light activity (OR = 0.92, CI = 0.84-1.01). There was a significant decreasing trend in the ORs from sedentary to heavy work (P = 0.007). Although limited by exposure misclassification, these data are consistent with the hypothesis that physical activity reduces the risk of breast cancer.

Reproductive factors and the risk of brain tumors: a population-based study in Sweden.

Possible associations between childbearing and the risk of brain cancer were explored in a case-control study "nested" within a large nationwide cohort defined by the Swedish Fertility Registry. Among women born between 1925-1975, 1,088 patients with meningiomas and 1,657 patients with gliomas were identified in the Swedish Cancer Registry. For every woman diagnosed with brain tumor, 5 age-matched controls were selected among those in the Fertility Registry. Relative risks were estimated by odds ratios from conditional logistic regression. Ever-parous women were at a reduced risk of glioma compared to nulliparous women, while parity was unrelated to meningioma risk. Age at first birth was unrelated to both meningioma and glioma risk. The gradient in risk between ever-parous and nulliparous women for gliomas, but not meningiomas, is difficult to explain biologically. A possible explanation is that pregnancy-induced alterations in androgen levels reduce the risk of glioma in parous women. Alternatively, childlessness may represent a marker of an occult glioma, negatively affecting fecundity. Overall, our present results do not support the notion that hormonal changes, or other physiological changes induced by childbearing, play an important role in the development of brain tumors.

Complications concerning free rectus abdominis muscle flaps in patients with portal hypertension.

A high level of suspicion is required when treating patients with a history of esophageal bleeding and portal hypertension. The preoperative workup must be extensive; if the reconstructive surgeon is considering the use of a rectus abdominis muscle transfer, noninvasive studies and an exhaustive physical examination are required. Factors affecting the microcirculation might also influence the patency rates of the venous anastomosis and require further study. When treating these patients, the surgeon must be aware that portal hypertension can exist without clinical evidence.

Variation in female breast cancer risk by occupation.

Data from a population-based case control study were used to estimate occupation-specific relative risks for female breast cancer, adjusted for established breast cancer risk factors. Breast cancer cases under age 75 were identified from tumor registries in four states. Controls were randomly selected from driver's license and Medicare beneficiary lists. Information on usual occupation and risk factors was obtained by telephone interview. Odds ratios from logistic regression adjusted for age, state, body mass index, benign breast disease, family history of breast cancer, menopausal status, age at menarche, parity, age of first birth, lactation history, education, and alcohol consumption were calculated for each of 26 occupational groups. Complete occupational information was obtained for 6,835 cases and 9,453 controls. Of 26 occupational groups, only "administrative support occupations" had a statistically significantly increased risk of breast cancer (OR = 1.15, 95% CI 1.06-1.24). In these data, no specific occupational group had an unusual risk of breast cancer. Increased risks reported elsewhere for nurses and teachers were not corroborated.