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SummaryBackgroundPublished findings on breast cancer risk associated with different types of menopausal hormone therapy (MHT) are inconsistent, with limited information on long-term effects. We bring together the epidemiological evidence, published and unpublished, on these associations, and review the relevant randomised evidence.MethodsPrincipal analyses used individual participant data from all eligible prospective studies that had sought information on the type and timing of MHT use; the main analyses are of individuals with complete information on this. Studies were identified by searching many formal and informal sources regularly from Jan 1, 1992, to Jan 1, 2018. Current users were included up to 5 years (mean 1·4 years) after last-reported MHT use. Logistic regression yielded adjusted risk ratios (RRs) comparing particular groups of MHT users versus never users.FindingsDuring prospective follow-up, 108 647 postmenopausal women developed breast cancer at mean age 65 years (SD 7); 55 575 (51%) had used MHT. Among women with complete information, mean MHT duration was 10 years (SD 6) in current users and 7 years (SD 6) in past users, and mean age was 50 years (SD 5) at menopause and 50 years (SD 6) at starting MHT. Every MHT type, except vaginal oestrogens, was associated with excess breast cancer risks, which increased steadily with duration of use and were greater for oestrogen-progestagen than oestrogen-only preparations. Among current users, these excess risks were definite even during years 1–4 (oestrogen-progestagen RR 1·60, 95% CI 1·52–1·69; oestrogen-only RR 1·17, 1·10–1·26), and were twice as great during years 5–14 (oestrogen-progestagen RR 2·08, 2·02–2·15; oestrogen-only RR 1·33, 1·28–1·37). The oestrogen-progestagen risks during years 5–14 were greater with daily than with less frequent progestagen use (RR 2·30, 2·21–2·40 vs 1·93, 1·84–2·01; heterogeneity p<0·0001). For a given preparation, the RRs during years 5–14 of current use were much greater for oestrogen-receptor-positive tumours than for oestrogen-receptor-negative tumours, were similar for women starting MHT at ages 40–44, 45–49, 50–54, and 55–59 years, and were attenuated by starting after age 60 years or by adiposity (with little risk from oestrogen-only MHT in women who were obese). After ceasing MHT, some excess risk persisted for more than 10 years; its magnitude depended on the duration of previous use, with little excess following less than 1 year of MHT use.InterpretationIf these associations are largely causal, then for women of average weight in developed countries, 5 years of MHT, starting at age 50 years, would increase breast cancer incidence at ages 50–69 years by about one in every 50 users of oestrogen plus daily progestagen preparations; one in every 70 users of oestrogen plus intermittent progestagen preparations; and one in every 200 users of oestrogen-only preparations. The corresponding excesses from 10 years of MHT would be about twice as great.FundingCancer Research UK and the Medical Research Council.

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, P50.00001) for an intake of 35 -44 g per day alcohol, and 1.46 (1.33 -1.61, P50.00001) for 545 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5 -8.7%; P50.00001) 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, P50.00001, 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. Many epidemiological studies have investigated the relationship between breast cancer and the consumption of alcohol and/or tobacco. References to over 80 studies that have collected relevant data, as well as to reviews of the subject, are given in Appendix II (www. bjcancer.com). The published results from these studies have general...

We studied the incidence of referral for treatment of end-stage renal disease (ESRD) in the Kaiser Foundation Health Plan (KFHP) in northern California from 1972California from through 1977. In this population of over 1 million persons, we found an age-adjusted annual incidence of 44.9 per million after 1973, when the Federal ESRD Program went into effect. Agespecific incidence was highest in men .70 years of age and in women in the 50-to 59-year age group; the male/ female ratio was 1.4:1. The most common diagnoses of patients referred with ESRD were glomerulonephritis

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Summary Over one billion people worldwide have high blood pressure. Many of the medications used to treat high blood pressure are photosensitizing, meaning they make the skin more sensitive to sunlight. As a result, these medications might increase the risk of skin cancer, the most common type of cancer worldwide. This study, from the U.S.A., aimed to find out if people who take blood pressure medications with photosensitizing properties have an increased risk of a certain type of skin cancer called cutaneous squamous cell carcinoma, the second most common type of skin cancer. The researchers identified a group of patients with high blood pressure and looked at what blood pressure medications they took and whether they were ever diagnosed with cutaneous squamous cell carcinoma. The researchers found that patients who take blood pressure medications with photosensitizing properties, including loop diuretics, potassium‐sparing diuretics, and thiazide diuretics, have an increased risk of cutaneous squamous cell carcinoma. The researchers found that the more prescriptions for these medications the patients received, the higher their risk of cutaneous squamous cell carcinoma was. This study suggests that patients taking blood pressure medications with photosensitizing properties may benefit from education on safe sun practices and closer screening for cutaneous squamous cell carcinoma.

Brain tumors are the second most common neoplasm in children. Pattern of primary brain tumors in children have not been reported in Iran. Brain tumors have been the subject of controversy both with respect to pattern of occurrence and to potential causes. The objective of the present study was to determine the histopathological pattern of intracranial tumors and its frequency by sex and age in children less than 15 years of age. A retrospective study of 633 children who were admitted at the neurosurgical center between 1978 and 2003 was performed. Charts were reviewed to extract information about demographics, and histopathological diagnosis of tumors. All patients entered into this study had pathologically proven brain tumor. The frequency distribution of brain tumors by age and sex, and histopathology was calculated. The male-female ratio was 58.1% to 41.9%, vary significantly (P < .05). The mean age of the patients at time of diagnosis was 8.79 years (SD ¼ 3.89). The five most common histological diagnoses in patients were Astrocytoma (39.5%), followed by Medulloblastoma (18.0%), Ependymoma (10.3%), Craniopharyngioma (8.7%), and Meningioma (5.7%). Most of brain tumor types (85%) occurred in children between 5 to 15 years of age. Astrocytoma was occurred mostly in children aged 5-15yrs (87%). Males were affected more than females. A significant male predominance was observed in the Craniopharyngioma and Medulloblastoma. Astrocytoma was the first most common brain tumor in all age groups. Certain tumor types show a prediction for the certain period of life. Keywords: Epidemiology, Brain tumors, Children. Previous reports disagree about whether cigarette smoking is related to risk of female breast cancer (BRCA). We did a cohort study among 70,033 women (59% white, 26% African-American, 10% Asian-American, 4% Hispanic, 1% Other) who supplied baseline information about demographics and habits at voluntary health examinations in 1978-85. Through 2004 BRCA was subsequently diagnosed in 2,829 women. We studied risk related to smoking by Cox proportional hazards models with never smokers (36,813 women; 1,440 BRCA) as the referent. Other smoking categories in the models were ex-smokers (12, 575 women; 613 BRCA), smokers of < 1 pack per day (12,383 women; 435 BRCA), and smokers of > 1 pack per day (5,573 women, 234 BRCA). In a model adjusted for age, ethnicity, body mass index, education, and alcohol drinking, the relative risks (RR), 95 % (confidence intervals [CI], p values) were: ex-smokers ¼ 1.11 (1.00-1.22, p ¼ 0.04), < 1 pack per day ¼ 1.15 (1.03-1.29, p ¼ 0.01), and > 1 pack per day ¼ 1.45 (1.25-1.68, p < 0.001). Additional control for pregnancy history and family breast cancer history had little effect on these RR's. Among covariates, increasing age, body mass index, education, and alcohol consumption showed positive relations to risk of BRCA, while AfricanAmerican ethnicity (vs white) was inversely related. Smoking associated risk was generally similar in subgroups stratified by age, ethnicity, body mass index,...

Cutaneous T-cell lymphomas (CTCL) are the most common lymphomas of the skin. Geographic clustering of CTCL cases in certain communities in Texas and Pittsburgh, PA implicate possible external triggers/promoter for this malignancy. We examined patient clinical characteristics, incidence, mortality trends and geographic distribution of CTCL cases in Canada by analyzing three independent population-based databases (Canadian Cancer Registry, Registre Québécois du Cancer and the Canadian Vital Statistics) during 1992-2010 using ICD-O-3, ICD-9 and ICD-10 codes for 10 CTCL subtypes. In total, 6685 patients were identified, of which 58.0% were males (male to female incidence ratio of 1.4). Mean age at diagnosis was 59.4AE21.5 years and w52% of patients were older than 60 at the time of diagnosis. Incidence rates of CTCL in Canada were rising during 1992-98 then stabilized at 11.32 cases per million individuals per year (95% CI: 11.05-11.59). Analysis by forward sortation areas (FSA) identified select regions, where several high-incidence FSAs were contiguous or adjacent. In several cities including Montréal, Hamilton, Oakville and Winnipeg, high-incidence FSAs were located in heavy industrial areas. In contrast, 3/8 lowincidence (0 cases during 1992-2010) populous FSAs clustered in Ottawa, which has very little industrial presence. Similarly, Quebec City (provincial capital) and Gatineau too had significantly lower CTCL incidence rates. Analysis of CTCL mortality rate of 0.38 deaths per million individuals per year, 95% CI: 0.33-0.43), corroborated the presented incidence findings. These results for the first time provide a comprehensive analysis of CTCL burden in Canada (by province, city and FSA) and identify important geographic case clustering areas that indicate industrial exposures may play an important role in lymphomagenesis.