Risk factors for colorectal cancer in a prospective study among U.S. white men.

The association of diet, smoking/drinking and occupation with subsequent risk of fatal colorectal cancer was investigated in a cohort of 17,633 white males aged 35 and older, who completed a mail questionnaire in 1966. During the subsequent 20 years of follow-up, 120 colon cancer and 25 rectal cancer deaths were identified. Due to small numbers, no significant dose-response trends were observed in the study, but risk of colon cancer was elevated among heavy cigarette smokers (> or = 30/day; RR = 2.3, 95% CI 0.9-5.7), heavy beer drinkers (> or = 14 times/month; RR = 1.9, 95% CI 1.0-3.8) and white-collar workers (RR = 1.7, 95% CI 1.0-3.0) or crafts workers within service and trade industries (RR = 2.6, 95% CI 1.1-5.8). In addition, an increased risk was seen for those who consumed red meat more than twice a day (RR = 1.8, 95% CI 0.8-4.4). Risk patterns for cancers of the colon and rectum combined were similar to those reported for cancer of the colon, but the estimates were somewhat dampened. Our findings support previous reports that a high intake of red meat and a sedentary life-style may increase the risk of colon cancer.

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. Dietary analyses 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.

Is cigarette smoking a risk factor for non-Hodgkin's lymphoma or multiple myeloma? Results from the Lutheran Brotherhood Cohort Study.

Among 17,633 U.S. white male insurance policy holders whose use of tobacco was characterized in a 1966 self-administered questionnaire, there were 49 deaths from non-Hodgkin's lymphoma (NHL) and 21 from multiple myeloma (MM) during a 20-year follow-up. Men who had ever smoked cigarettes had an elevated mortality from NHL (RR = 2.1; CI = 0.9-4.9), with risk almost four-fold greater among the heaviest smokers (RR = 3.8; CI = 1.4-10.1) compared with those who used no tobacco. In contrast, risk of MM was only slightly elevated among those who had ever smoked cigarettes (RR = 1.3; CI = 0.4-3.9) and without evidence of a dose-response trend. Since this is the first cohort study suggesting a link between cigarette smoking and NHL and findings from case-control studies have been inconsistent, additional clarification should be sought from larger incidence-based cohort investigations.

A cohort study of tobacco use, diet, occupation, and lung cancer mortality.

In 1966, a cohort of White males aged 35 or over, who were policy-holders with the Lutheran Brotherhood Insurance Society (United States), completed a mail questionnaire on tobacco use, diet, and demographic characteristics. During the 20 years of follow-up, 219 lung cancer deaths occurred. Besides the strong relationship with cigarette smoking, we observed an effect on lung cancer risk among current users of cigars or pipes who were nonsmokers of cigarettes (relative risk [RR] = 3.5, 95 percent confidence interval [CI] = 1.0-12.6) or who were past/occasional users of cigarettes (RR = 2.7, CI = 1.4-5.3). In addition, elevated risks (from 1.5 to 2.6) of lung cancer were found among craftsmen and laborers, with the highest risks among subjects who worked in the mining or manufacturing industry. No association between current (as of 1966) use of beer or hard liquor and lung cancer was observed, although past users were at elevated risk. An inverse association between lung cancer and intake of fruits was observed, and risks of lung cancer were lower among persons in the highest dietary intake quintiles of vitamins A and C. Except for oranges, however, none of the inverse associations with fruits or dietary nutrients had statistically significant trends. The findings from this cohort study add to the evidence of an adverse effect of cigar/pipe smoking and possibly protective effect of dietary factors on lung cancer risk.

Cigarette smoking and leukemia: results from the Lutheran Brotherhood Cohort Study.

In a 20-year follow-up (1966-86) of 17,633 White males who described tobacco use in a mailed questionnaire sent in 1966, there were 74 deaths from leukemia (including 30 myeloid, 30 lymphatic, and 14 other and unspecified leukemia). Among men who ever smoked cigarettes, increased risks were observed for lymphatic (relative risk [RR] = 2.7), and other and unspecified leukemia (RR = 1.5); risks rose with increasing number of cigarettes smoked, although the dose-response relationship was statistically significant only for total leukemia. Mortality from myeloid leukemia was not elevated, except among those smoking over a pack of cigarettes per day. Results from this cohort support a relationship between cigarette smoking and leukemia. Further studies are needed to elucidate subtype associations with cigarette smoking.

A cohort study of stomach cancer in a high-risk American population.

Demographic, smoking and dietary information was obtained from a cohort of 17,633 white American men, largely of Scandinavian and German descent, who responded to a mailed questionnaire in 1966. After 20 years of follow-up, 50% to 90% increases in mortality from stomach cancer (75 deaths) were found among foreign-born, their children, and among residents of the North Central states. An association was seen with low educational attainment and laboring or semiskilled occupations, primarily among immigrants and their children. Risk was evaluated in subjects who regularly smoked cigarettes (RR = 2.6, 95% CI = 1.1 to 5.8). A significant dose-response trend was observed, with subjects who smoked 30 or more cigarettes per day having more than a five-fold increased risk compared with those who never smoked. Elevated risks were also found for pipe smoking and smokeless tobacco use, but not for alcohol consumption. Analysis of dietary consumption of nine food groups revealed no significant associations with stomach cancer. However, total carbohydrate intake and a few individual food items (salted fish, bacon, cooked cereal, milk, and apples) were associated with increased risk. The findings of this prospective study of a high-risk population add to the limited evidence relating tobacco consumption to stomach cancer risk and suggest clues to ethnic, geographic, and dietary risk factors.

Diet, tobacco use, and fatal prostate cancer: results from the Lutheran Brotherhood Cohort Study.

A cohort of 17,633 white males age 35 and older responded to a mailed epidemiological questionnaire in 1966 and was followed until 1986 to determine the risk of cancer associated with diet, tobacco use, and other factors. During the 20-year follow-up, 149 fatal prostate cancer cases were identified. Relative risks for prostate cancer were significantly elevated among cigarette smokers (relative risk, 1.8; 95% confidence interval, 1.1-2.9) and users of smokeless tobacco (relative risk, 2.1; 95% confidence interval, 1.1-4.1). No significant associations were found with frequency of consumption of meats, dairy products, fruits, or vegetables. There were no overall significant associations between consumption of vitamin A from animal sources (retinol) and provitamin A from plant sources (carotene) and risk, but positive trends were seen for ages under 75, while inverse associations were found at older ages. Beverage consumption, including drinking coffee and alcohol, was unrelated to risk. Marital status, education, rural/urban status, and farming residence were also unrelated to the risk of fatal prostate cancer. The findings add to limited evidence that tobacco may be a risk factor for prostate cancer, but fail to provide clues to dietary or other risk factors.

Milk consumption and cancer incidence: a Norwegian prospective study.

Relationships between milk intake and cancer incidence were investigated after 11 1/2 years of follow-up of 15,914 individuals. A diagnosis of cancer was made in a total of 1,422 individuals. No association was established with total cancer incidence, in analyses adjusted for sex, age and residential characteristics. However, a strong positive association with milk consumption was observed for cancers of the lymphatic organs (odds ratio 3.4 for greater than or equal to 2 glasses per day vs less than 1; 95% confidence interval 1.4-8.2). An inverse association was found for cancer of the bladder. Kidney cancer and cancers of the female reproductive organs (except the uterine cervix) showed weak positive associations with milk intake.

Cancer in waiters.

The risk of cancer was studied in 2,413 males registered as waiters at the 1960 census in Norway. A personal identification number was used in linking this cohort of waiters with the Norwegian Cancer Registry. The follow-up period was 1961-1984. An excess risk of cancer was observed for the following primary sites: upper respiratory and digestive tracts combined 42 observed against 11.3 expected, liver (14 versus 2.87), rectum (28 versus 13.89), and lung (67 versus 43.66). The highest risk for all these types of cancer was seen among those who were waiters at both censuses in 1960 and 1970. In the case of cancer of the stomach the observed number of cases was significantly lower than expected (14 versus 25.68). It is known that smoking habits and alcohol consumption are substantial aetiological factors for the types of cancer in which an excess risk has been demonstrated here.

Lifestyle and mortality among Norwegian men.

Information on six different habits (cigarette smoking, physical activity, frequency of alcohol and of fruit/vegetable consumption, and daily bread and potato consumption) was obtained by two postal surveys (1964 and 1967) among Norwegian men. The answers were related to mortality among 10,187 respondents ages 35-74 years at the start of the follow-up period (1967-1978). Analyses, stratified by age, place of residence, marital status, and socioeconomic group, showed an association between the six variables and observed/expected deaths, as well as odds ratio estimates. A health practice score, obtained by adding the number of favorable habits, showed a strong inverse relationship with total mortality as well as deaths from cancer, cardiovascular diseases, and other causes. Odds ratio estimates for men with only favorable habits vs those with at most one such habit, were 0.31 for total mortality, 0.44 for cancer, and 0.36 for cardiovascular mortality. Separate analyses among current smokers and nonsmokers showed a particularly strong association between the five other habits and mortality from cardiovascular disease.

Coffee drinking, mortality, and cancer incidence: results from a Norwegian prospective study.

Relationships between coffee consumption and occurrence of cancer as well as mortality were explored in a Norwegian study of 13,664 men and 2,891 women who in 1967-69 reported their coffee consumption. No statistically significant positive associations were found between coffee consumption and disease. A weak negative association was found with total cancer incidence even when the first 4 of the 11 1/2 years of follow-up were excluded, and strong negative associations with coffee drinking were noted for cancer of the kidney and nonmelanoma skin cancer. For cancer of the pancreas and bladder, no increase in incidence was found among those with a high coffee consumption. In subjects less than 65 years of age at start of follow-up, coffee drinking showed a significant inverse association with colon cancer.

Occupational exposure and lung cancer risk.

The importance of occupation held longest as a risk factor for lung cancer was examined in a prospective study in Norway of 11,995 men, among whom 125 cases occurred in a follow-up from 1966 through 1978. Based on information about occupation held longest, the respondents were classified into 3 groups according to suspected exposure to respiratory carcinogens at the workplace. After stratification for age, place of residence and cigarette smoking, we found a highly significant relative risk of 2.6 for those judged to have experienced definite exposure versus the group with no workplace exposure. The apparent risk-enhancing effect of occupational exposure was observed for all histologic subtypes. Stratification including a socioeconomic factor score led to a moderate reduction in the relative risk estimate. High risk estimates still obtained, however, for a limited number of occupations, the highest for workers in the mining and quarrying industries. Although the interpretation of the observed effect associated with a crude index of occupational exposure may be difficult, our results suggest that between 13 and 27% of the lung cancer cases observed among Norwegian men in the relevant time period can be attributed to harmful work-place exposure.

Use of alcohol, tobacco and coffee, and risk of pancreatic cancer.

Associations between pancreatic cancer and use of alcohol, tobacco and coffee were examined in a Norwegian prospective study of 16,713 individuals in which 63 cases occurred. The associations were assessed using techniques for stratified logistic regression. Of the potential risk factors considered, use of alcohol showed the strongest positive association, with an estimated relative risk of 5.4 for those with a frequent use as compared with non-drinkers (P less than 0.001). A clear positive association was also obtained with chewing of tobacco or use of snuff. For cigarette smoking a somewhat weaker association was observed. No association could be established for pipe smoking or coffee drinking. In general, more clear-cut results were found when analysis was restricted to histologically-verified cases.

Dietary habits and lung cancer risk.

A previously reported negative association between a high index of dietary vitamin A and lung cancer incidence was confirmed in an extended follow-up, covering 11 1/2 years, of 13,785 men and 2,928 women, Responses to a postal questionnaire provided the dietary information. Relationships between the major dietary items and lung cancer were explored for various diagnostic subsets of the 168 lung cancer cases diagnosed among the study subjects. Analyses were stratified for sex, age, residence characteristics, cigarette smoking and, at times, socioeconomic group. Although the data do not permit a firm interpretation in terms of risk enhancement by a marginal retinoid deficiency, we found that the apparent protection afforded by higher intakes of vitamin A or its provitamins was particularly strong for lung cancer appearing as squamous-cell carcinoma and among those with higher alcohol intakes. The individual food items which showed the strongest negative association with lung cancer were carrots and milk. These two items made a major contribution to the vitamin A index and its variation among the respondents.

Coffee consumption and mortality from ischemic heart disease and other causes: results from the Lutheran Brotherhood study, 1966-1978.

In this cohort study, 16,911 men who had completed a mailed dietary questionnaire were followed for 11 1/2 years with 721 deaths reported from ischemic heart disease (IHD) (excluding those reporting on the questionnaire a prior history of angina or other heart conditions). Although no association was found between coffee consumption and mortality from IHD, a negative association between coffee consumption and mortality from diseases other than IHD was found. This negative association, found exclusively in the first four years of follow-up, was observed in deaths from digestive diseases, other than malignancies, and paralysis agitans, which made the greatest contribution to this observed negative association. The negative association appeared to reflect a reduction in coffee consumption related to the disorders in question and not to a protective effect of coffee. It has been suggested that the positive association between coffee consumption and IHD reported in some case-control studies may reflect a decreased consumption among controls rather than an unusually high consumption among cases.

Dietary vitamin A and human lung cancer.

Five-year follow-up results for 8,278 men who in mail surveys had reported their cigarette smoking and dietary habits showed: (1) an index for vitamin A intake to be negatively associated with lung cancer incidence at all levels of cigarette smoking;(2) this association to be more clearly expressed in the subset of histologically proven pulmonary carcinomas other than adenocarcinoma; and (3) the positive association between cigarette smoking and lung cancer to obtain irrespective of the dietary level of vitamin A or related factors. The findings are in accordance with experimental results on animals and call for further exploration of the role of nutritional factors in the development of human lung cancer.