Incidental pulmonary nodules are an increasingly common consequence of routine medical care, with an incidence that is much greater than recognized previously. More frequent nodule identification has not been accompanied by increases in the diagnosis of cancerous nodules.

Objective: Identify risk factors for urinary incontinence in middle-aged women.Study Design: Cross-sectional analysis of 83,355 Nurses' Health Study II participants. Since 1989, women have provided health information on mailed questionnaires; in 2001, at age 37-54 years, information on urinary incontinence was requested. We examined adjusted odds ratios of incontinence using logistic regression.Results: 43% of women reported incontinence. After adjustment, African-American (OR=0.49, 95% CI 0.40-0.60) and Asian-American women (OR=0.57, 95% CI 0.46-0.72) were at reduced odds of severe incontinence compared to Caucasians. Increased age, body mass index, and parity were all positively associated with incontinence, as were current smoking, type 2 diabetes, and hysterectomy. Women aged 50-54 years had 1.81 times the odds of severe incontinence compared to women <40 years (95% CI 1.66-1.97); women with BMI ≥ 30 kg/m 2 had 3.10 times the odds of severe incontinence compared to BMI 22-24 kg/m 2 (95% CI 2.91-3.30).Conclusions: Urinary incontinence is highly prevalent among these middle-aged women. Potential risk factors include age, race/ethnicity, body mass index, parity, smoking, diabetes, and hysterectomy.

II.

These data support a linear inverse association between breastfeeding and risk of epithelial ovarian cancer.

Convincing epidemiologic evidence links excess body mass to increased risks of endometrial and postmenopausal breast cancers but the relation of body mass index (BMI) to ovarian cancer risk remains inconclusive. Potential similarities regarding a hormonal mechanism in the etiology of female cancers highlight the importance of investigating associations according to menopausal hormone therapy (MHT) use. However, data addressing whether the relation of BMI to ovarian cancer differs by MHT use are very sparse. We prospectively investigated the association between BMI and ovarian cancer among 94,525 U.S. women, followed from 1996–1997 to December 31, 2003. During 7 years of follow-up, we documented 303 epithelial ovarian cancer cases. As compared with normal weight women (BMI 18.5–24.9 kg/m2), the multivariate relative risk (MVRR) of ovarian cancer for obese women (BMI ≥30 kg/m2) in the cohort as a whole was 1.25 (95%-CI=0.93–1.68). Among women who never used MHT, the MVRR for obese versus normal weight women was 1.80 (95%-CI=1.16–2.80). In contrast, no relation between BMI and ovarian cancer was apparent among women who ever used MHT (MVRR=0.96; 95%-CI=0.64–1.43; P-interaction=0.02). Exploratory analyses also suggested a positive association between BMI and ovarian cancer among women without a family history of ovarian cancer (MVRR comparing obese versus normal weight women=1.36; 95%-CI=0.99–1.85), but no relation with BMI was apparent among women with a positive family history of ovarian cancer (MVRR=0.73; 95%-CI=0.34–1.60; P-interaction=0.02). We suspect that obesity is associated with enhanced ovarian cancer risk through a hormonal mechanism.

Circadian genes influence a variety of biological processes that are important in prostate tumorigenesis including metabolism. To determine if variants in circadian genes alter prostate cancer risk, we genotyped five variants in five circadian genes in a population-based case-control study conducted in China (187 cases and 242 controls). These variants included CRY2 rs1401417:G4C, CSNK1E rs1005473:A4C, NPAS2 rs2305160:G4A, PER1 rs2585405:G4C and PER3 54-bp repeat length variant. Men with the cryptochrome 2 (CRY2)-variant C allele had a significant 1.7-fold increased prostate cancer risk (95% confidence interval (CI), 1.1-2.7) relative to those with the GG genotype. This risk increased to 4.1-fold (95% CI, 2.2-8.0) in men who also had greater insulin resistance (IR) as compared to men with the GG genotype and less IR. In contrast, among men with less IR, the NPAS2-variant A allele was associated with decreased prostate cancer risk (odds ratio ¼ 0.5, 95% CI, 0.3-1.0) as compared to the GG genotype. Our findings, although in need of confirmation, suggest that variations in circadian genes may alter prostate cancer risk and some biological processes may modify this effect.

The relationship between postmenopausal hormone use (PMH) and ovarian cancer risk is unclear, particularly for specific hormone formulations, but recent studies suggest that there is a positive association. We conducted a prospective observational study with 82 905 postmenopausal women, including 389 ovarian cancers, in the Nurses' Health Study from 1976 to 2002. Compared with never users of PMH, both current and past users of X5 years had a significantly elevated risk of ovarian cancer (RR ¼ 1.41, 95% confidence interval (CI) 1.07 -1.86 and relative risk (RR) ¼ 1.52, 95% CI 1.01 -2.27, respectively). Examined by hormone type in continuous years, use of unopposed estrogen was associated with a significant increase in the risk of epithelial ovarian cancer (P for trend o0.001; RR for 5-year increment of use ¼ 1.25, 95% CI 1.12 -1.38). Use of estrogen plus progestin (RR for 5-year increment of use ¼ 1.04, 95% CI 0.82 -1.32) was not significantly associated with ovarian cancer risk. Generally, results were similar for serous tumours (RR for 5-year increment of unopposed estrogen use ¼ 1.23, 95% CI 1.07 -1.40) and slightly stronger for endometrioid tumours (RR for 5-year increment of unopposed estrogen use ¼ 1.53, 95% CI 1.20 -1.94). Recency of use was not significantly associated with ovarian cancer risk, but statistical power was limited here.

Biliary tract cancers, encompassing the gallbladder, extrahepatic bile ducts and ampulla of Vater, are rare but highly fatal malignancies. Gallstones, the predominant risk factor for biliary cancers, are linked with hyperlipidemia. As part of a populationbased case-control study conducted in Shanghai, China, we examined the associations of serum lipid levels with biliary stones and cancers. We included 460 biliary cancer cases (264 gallbladder, 141 extrahepatic bile duct, and 55 ampulla of Vater), 981 biliary stone cases and 858 healthy individuals randomly selected from the population. Participants completed an in-person interview and gave overnight fasting blood samples. Participants in the highest quintile of triglycerides (≥160 mg/dl) had a 1.4-fold risk of biliary stones (95% CI 5 1.1-1.9), a 1.9-fold risk of gallbladder cancer (95% CI 5 1.3-2.8), and a 4.8-fold risk of bile duct cancer (95% CI 5 2.8-8.1), compared to the reference group (third quintile: 90-124 mg/dl). Participants in the lowest quintile of high-density lipoprotein (HDL) (<30 mg/dl) had a 4.2-fold risk of biliary stones (95% CI 5 3.0-6.0), an 11.6-fold risk of gallbladder cancer (95% CI 5 7.3-18.5), and a 16.8-fold risk of bile duct cancer (95% CI 5 9.1-30.9), relative to the reference group (third quintile: 40-49 mg/dl). In addition, total cholesterol, low-density lipoprotein (LDL) and apolipoprotein A (apo A) were inversely associated with biliary stones; whereas low levels as well as high levels of total cholesterol, LDL, apo A and apolipoprotein B (apo B) were associated with excess risks of biliary tract cancers. Our findings support a role for serum lipids in gallstone development and biliary carcinogenesis. ' 2007 Wiley-Liss, Inc.Key words: serum lipid levels; gallstones; biliary tract cancer Biliary tract cancers, consisting of tumors of the gallbladder, extrahepatic bile ducts and ampulla of Vater, are rare but highly fatal malignancies. 1,2 Gallstones are the most important known risk factor for all three biliary tract cancer subsites. Specifically, cholesterol gallstones (composed mainly of cholesterol) and mixed gallstones (composed of both cholesterol and bilirubin) are most strongly associated with gallbladder cancer. 2,3 Furthermore, cholesterol gallstones and gallbladder cancer share a number of putative risk factors, including obesity, high fat diet and hyperlipidemia. 2,4 Hyperlipidemia is generally characterized by high serum levels of total cholesterol, triglycerides, low-density-lipoprotein (LDL), and low levels of high-density-lipoprotein (HDL). High triglycerides and low HDL have been most consistently associated with gallstones, whereas the associations of total cholesterol and LDL with gallstones are less consistent. [5][6][7] Cholesterol gallstone pathogenesis involves cholesterol saturation of the bile duct due to the hypersecretion of cholesterol from the liver 8 ; however, the exact role of individual lipids, lipoproteins and apolipoproteins is less clear.Given the relationship between hyperlipidemia and gallsto...