Dietary and lifestyle characteristics were evaluated in relation to subsequent prostatic cancer risk in a cohort of approximately 14,000 Seventh-day Adventist men who completed a detailed lifestyle questionnaire in 1976 and who were monitored for cancer incidence until the end of 1982. During the 6-year follow-up period, 180 histologically confirmed prostatic cancers were detected among some 78,000 man-years of follow-up. Increasing educational attainment was associated with significantly decreased risk of prostate cancer in this study; age at first marriage was also inversely associated with risk, although this was not significant. There was no relationship between body mass index (as measured by Quetelet's Index) and risk. A history of prostate '%rouble" was associated with a 60% increase in risk which was highly significant.Although there were suggestive relationships between increasing animal product consumption and increased risk, these results did not persist after accounting for the influence of fruit and vegetable consumption. Nor was exposure to the vegetarian lifestyle during the childhood years associated with alterations in subsequent risk. However, increasing consumption of beans, lentils and peas, tomatoes, raisin, dates, and other dried fruit were all associated with significantly decreased prostate cancer risk.Cancer 64:598-604, 1989.ANCER OF THE PROSTATE is the second most Corn-C mon malignancy among men in the United States, ranking only behind lung cancer. Among men, 20% of all newly diagnosed cancers are prostatic cancer and they comprise 1 1 % of all male cancer deaths. Incidence rates have been increasing during the last several decades.' Various factors have been investigated in regard to the etiology of this cancer including socioeconomic status, sexual activity, marital status, venereal disease, and race. The incidence rates for blacks in the United States are the highest recorded in the world. Dietary habits have also been related to this cancer by some investigators. Diets rich in animal fat appear to be associated with increased risk for prostatic cancer. In ecologic studies there is a strong positive correlation between dietary fat consumption and prostatic cancer incidence worldwide.* Within the US prostatic cancer mortality rates are highest in counties with the highest fat consumption.' Also, prostatic cancer is increasing in Japan which is experiencing From the Department of Preventive Medicine, Lorna Linda University increases in fat consumption. The migrant studies of Japanese (and Polish) in the US also support some of the hypotheses relating dietary practices common to the western diet to the etiology of prostate cancer.Previous studies among Seventh-day Adventist vegetarians have found lower rates for prostate cancer4 as compared to other white men in California. Fatal prostate cancer risk among Adventists has been associated with increasing milk consumption and over~eight.~ Hirayama has provided evidence that men who eat green and yellow vegetables on a daily basis have low...

Background Differences in the breast cancer burden of African American compared with White American women are well-documented. Recent controversies have emerged regarding age-appropriate mammographic screening guidelines, and these surveillance recommendations may influence future breast cancer disparities. Our goal was to evaluate age-specific breast cancer stage distributions and incidence rates of triple-negative breast cancer (TNBC) in a population-based tumor registry. Study Design We analyzed California Cancer Registry (CCR) breast cancers diagnosed 1988 – 2006. Results were stratified by age and race/ethnicity, with White Americans identified as Non-Hispanic Whites (NHW) and African Americans as Non-Hispanic Blacks (NHB). Breast cancer stage distributions and TNBC incidence rates were also analyzed. Results A total of 375,761 invasive breast cancers were evaluated (including 276,938 in NHW and 21,681 in NHB) NHB and Hispanics tended to be younger than NHW (median ages 57; 54; and 64 years, respectively). Lifetime incidence rates were higher for NHW compared to NHB and Hispanics, but for women younger than 44 years incidence was highest among NHB. NHB also had higher incidence rates of Stage III and IV disease, and higher incidence of TNBC in all age categories. Conclusions Population-based data demonstrate that African American women have a more advanced stage distribution for breast cancer compared to White Americans, and higher incidence rates for TNBC. These patterns are observed for women age 40–49 years as well as older women, and suggest that mammographic screening for early detection of breast cancer will be particularly relevant for younger African American women.

Epidemiologic studies of diet and pancreas cancer are few, and include ecologic comparisons and a limited number of prospective and case-control studies. Foods and/or nutrients that have been suggested to be associated with increased risk of this cancer include total fat intake, eggs, animal protein, sugar, meat, coffee and butter. Consumption of raw fruits and vegetables has been consistently associated with decreased risk. Dietary habits and medical history variables were evaluated in a prospective study of fatal pancreas cancer among 34,000 California Seventh-day Adventists between 1976 and 1983. Forty deaths from pancreas cancer occurred during the follow-up period. Compared to all US whites, Adventists experienced decreased risk from pancreas cancer death (standardized mortality ratio [SMR] = 72 for men; 90 for women), which was not statistically significant. Although there was a suggestive relationship between increasing meat, egg, and coffee consumption and increased pancreatic cancer risk, these variables were not significantly related to risk after controlling for cigarette smoking. However, increasing consumption of vegetarian protein products, beans, lentils, and peas as well as dried fruit was associated with highly significant protective relationships to pancreas cancer risk. A prior history of diabetes was associated with increased risk of subsequent fatal pancreas cancer, as was a history of surgery for peptic or duodenal ulcer. A history of tonsillectomy was associated with a slight, nonsignificant protective relationship as was history of various allergic reactions. These findings suggest that the protective relationships associated with frequent consumption of vegetables and fruits high in protease-inhibitor content are more important than any increase in pancreas cancer risk attendant on frequent consumption of meat or other animal products. Furthermore, the previously reported positive associations between diabetes and abdominal surgery and pancreas cancer risk are supported in these data.

The relation between allergy and risk of cancer was evaluated in a cohort study of 34,198 Seventh-day Adventists in California. Information on prevalence of asthma, hay fever, and reactions to chemicals, medications, bee stings, and poison oak (or ivy) was obtained by questionnaire in 1976. The reported allergies must have been serious enough to require treatment by a physician. The cohort was then followed for 6 years (1977-1982). Both stratified analysis and Cox proportional hazards regression analyses were utilized to evaluate the relation of allergy to cancer after taking into account several potentially confounding variables. For all cancer sites combined in males, there was a 33% increased risk associated with reaction to medications. In contrast, among females, reaction to medications was associated with a 21% decrease in risk. Both results were statistically significant. Prostate and breast cancer risk were elevated in persons who reported any type of allergic history, as was risk of lymphatic or hematopoietic cancers and sarcoma. For each of these types of cancer, risk increased with increasing numbers of allergies. However, ovarian cancer risk was decreased in persons with any allergic history and increasing numbers of allergies was associated with decreasing risk of this form of cancer. These results suggest that the association between allergy and cancer is complex and depends on the specific allergy and the specific organ site under consideration.

A cohort study of bladder cancer was conducted in a population of California Seventh-day Adventists. Most Seventh-day Adventists use neither tobacco nor alcohol yet experience a large degree of variation in dietary habits. Therefore, diet and other lifestyle habits were evaluated in this unique population. In 1976, 34,198 non-Hispanic white Seventh-day Adventists in California completed a detailed lifestyle questionnaire which included a 51-item food frequency section. This cohort was then followed until the end of 1982 during which time all newly diagnosed malignancies were detected. In order to evaluate the relation between several variables hypothesized to be associated with altered bladder cancer risk, age-, sex-, and smoking-adjusted relative risks (incidence rate ratios) were calculated using the method of Mantel-Haenszel adopted for person-time data. Multivariate analyses were conducted using the Cox Proportional Hazards Regression model. Between the return of the questionnaire and the end of follow-up, there were 52 histologically confirmed bladder cancers detected in the cohort. Increasing age, male gender, and a history of cigarette smoking were all significantly associated with increased bladder cancer risk. In addition, residence in a rural area was associated with significantly increased risk (relative risk (RR) = 1.80) as was high consumption of meat, poultry, and fish (RR = 2.57).

The Adventist Health Study is a prospective cohort study of 34,198 non-Hispanic white Seventh-day Adventists (13,857 men; 20,341 women, age 25-100 years) followed for 6 years (1977-1982). Within this population, 55.2% were lacto-ovovegetarian (consumed meat, poultry, or fish less than one time per week with no restrictions as to egg or dairy product consumption) in 1976 and most abstained from alcohol, tobacco, and pork products. Baseline data included demographic variables, information on current and past dietary habits, exercise patterns, use of prescription drugs, use of alcohol and tobacco, measures of religiosity, occupation and residential histories, anthropometric data, and menstrual and reproductive histories. Nonfatal case ascertainment was completed through review of self-reported hospitalizations obtained from annual self-administered mailed questionnaires and through computerized record linkage with two California population-based tumor registries. Fatal case ascertainment was completed via record linkage with computerized California state death certificate files, the National Death Index, and individual follow-up. During the 6 years of follow-up, 52.8% of the 34,198 study subjects reported at least one hospitalization. A total of 20,702 medical charts were reviewed for cancer and cardiovascular disease incidence and 1406 incident cancer cases and 2716 deaths from all causes were identified after baseline data collection.Cancer 64570-581, 1989.EVENTH-DAY ADVENTISTS (SDA) represent a unique S population in which to study the relationship between lifestyle (including dietary habits) and chronic disease. This conservative religious group prohibits the use of alcohol, tobacco, and pork and strongly recommends that members adhere to a lacto-ovovegetarian diet. In 1976, 55.2% of California SDA were lacto-ovovegetarian and many of the remainder ate relatively little meat. Lacto-ovovegetarianism was defined as consumption of meat, poultry, or fish less than once per week as we believed this level of consumption was not biologically important in the possible etiology of specific diseases. There were insufficient numbers of pure vegetarians (vegans: no consumption of animal products) to justify separate analyses. Furthermore, approximately 50% are adult converts

California farm workers employed where mancozeb and toxaphene were used had an increased risk of leukemia compared to farm workers employed elsewhere. Employment in farms using 2,4-D was associated with an increased risk of NHL.

We studied the occurrence of tumors of the brain and cranial meninges in a cohort of 34,000 California Seventh-Day Adventists who completed a detailed life-style questionnaire in 1976 and who were followed for cancer incidence until the end of 1982. During the period of follow-up, 31 tumors were diagnosed in the cohort (21 gliomas, 10 meningiomas). Increased risk for glioma was associated with rural residence, history of a positive tuberculosis skin test and consumption of pork products; increased meningioma risk was associated with a positive reaction to a tuberculosis skin test, previous stroke, use of tranquillizers and a vegetarian life-style in childhood.