Compared with the general population, members of Li-Fraumeni syndrome families have an exceptionally high risk of developing multiple primary cancers. The excess risk of additional primary cancers is mainly for cancers that are characteristic of Li-Fraumeni syndrome, with the highest risk observed for survivors of childhood cancers. Cancer survivors in these families should be closely monitored for early manifestations of new cancers.
A population-based case-control study was carried out among 981 men (479 black, 502 white) with pathologically confirmed prostate cancer and 1315 controls (594 black, 721 white). In-person interviews elicited information on sexual behaviour and other potential risk factors for prostate cancer. Blood was drawn for serologic studies in a subset of the cases (n = 276) and controls (n = 295). Prostate cancer risk was increased among men who reported a history of gonorrhoea or syphilis (odds ratio (OR) = 1.6; 95% confidence internal (CI) 1.2–2.1) or showed serological evidence of syphilis (MHA-TP) (OR = 1.8; 95% CI 1.0–3.5). Patterns of risk for gonorrhoea and syphilis were similar for blacks (OR = 1.7; 95% CI 1.2–2.2) and whites (OR = 1.6; 95% CI 0.8–3.2). Risks increased with increasing occurrences of gonorrhoea, rising to OR = 3.3 (95% CI 1.4–7.8) among subjects with three or more events (Ptrend= 0.0005). Frequent sexual encounters with prostitutes and failure to use condoms were also associated with increased risk. Syphilis, gonorrhoea, sex with prostitutes and unprotected sexual intercourse may be indicators of contact with a sexually transmissible factor that increases the risk of prostate cancer. © 2000 Cancer Research Campaign
To examine the association between gallstones and cholecystectomy, we conducted a nationwide population-based cohort study in Denmark. Patients with a discharge diagnosis of gallstones from 1977 to 1989 were identified from the Danish National Registry of Patients and followed up for cancer occurrence until death or the end of 1993 by record linkage to the Danish Cancer Registry. Included in the cohort were 60 176 patients, with 471 450 person–years of follow-up. Cancer risks were estimated by standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) stratified by years of follow-up and by cholecystectomy status. Among patients without cholecystectomy, the risks at 5 or more years of follow-up were significantly elevated for cancers of liver (SIR = 2.0, CI = 1.2–3.1) and gallbladder (SIR = 2.7, CI = 1.5–4.4) and near unity for cancers of extrahepatic bile duct (SIR = 1.1), ampulla of Vater (SIR = 1.0) and pancreas (SIR = 1.1). The excess risk of liver cancer was seen only among patients with a history of hepatic disease. Among cholecystectomy patients, the risks at 5 or more years of follow-up declined for cancers of liver (SIR = 1.1) and extrahepatic bile duct (SIR = 0.7), but were elevated for cancers of ampulla of Vater (SIR = 2.0, CI = 1.0–3.7) and pancreas (SIR = 1.3, CI = 1.1–1.6). These findings confirm that gallstone disease increases the risk of gallbladder cancer, whereas cholecystectomy appears to increase the risk of cancers of ampulla of Vater and pancreas. Further research is needed to clarify the carcinogenic risks associated with gallstones and cholecystectomy and to define the mechanisms involved. © 1999 Cancer Research Campaign
The relationship between menopausal oestrogen use and breast cancer risk has long been of interest, particularly given extensive evidence that endogenous hormones are involved in aetiology (Henderson et al., 1982) and that oestrogens can induce mammary neoplasms in experimental animals (IARC, 1979). Interest heightened when Hoover et al. (1976), in a retrospective cohort study of menopausal oestrogen users, showed that the risk of breast cancer increased with years since initial exposure, reaching a significant risk of 2.0 after 15 years. Subsequent case-control studies, however, yielded conflicting results (Jick et al., 1980;Ross et al., 1980;Hoover et al., 1981;Kelsey et al., 1981;Hulka et al., 1982;Hiatt et al., 1984;Kaufman et al., 1984;Nomura et al., 1986). Most failed to find evidence of any overall excess risk, although several indicated that long-term users might be adversely affected. A further complication was that hormone effects appeared to be modified by ovarian status, but various studies disagreed on which subgroups were at highest risk. The different subgroups included women with a natural menopause (Jick et al., 1980;Hulka et al., 1982), women whose ovaries were retained (Ross et al., 1980) and women having undergone a bilateral oophorectomy Hiatt et al., 1984). In addition, two large case-control studies (Kelsey et al., 1981;Kaufman et al., 1984) (Brinton et al., 1981). Although hormone use was not associated with any substantial overall risk, there was some hazard suggested among women who received hormones following bilateral oophorectomy, obliterating the protective effect normally associated with the operation. In this group, risk increased with years of oestrogen use, reaching risks of 2-3 for users of ten or more years.Higher risks were observed among oophorectomized women who used hormones in the presence of other risk factors, including nulliparity, family history of breast cancer, and benign breast disease.We subsequently had the opportunity to expand the original case-control study, concentrating on women whose breast cancer was detected during the latter years of the screening project. The extension of this study more than doubled our original sample size, enabling detailed evaluations of hypotheses raised by the initial investigation risks among hormone-susceptible subgroups, and relationships of hormone use to varying disease states. Subjects and methodsSubjects for this case-control study participated in the Breast Cancer Detection Demonstration Project (BCDDP), a multi-centre breast cancer screening program involving over 280,000 women at 29 widely dispersed centres. This program, jointly
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