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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Journal of cancer research and clinical oncology 117 (1991), S. 177-185 
    ISSN: 1432-1335
    Keywords: Cancer control ; Breast cancer ; Colorectal cancer ; Primary prevention ; Screening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Primary prevention of cancer requires control of both involuntary and voluntary exposures. Involuntary exposures include carcinogens in air and water, and various forms of radiation. Often these exposures are difficult to characterise individually and difficult to study epidemiologically. Although it is unlikely that they account for more than a small proportion of cancers, it is important that we refine our techniques of study to facilitate their control. Voluntary (lifestyle) exposures are responsible for the majority of cancers. In many developed countries, tobacco accounts for approximately 30% of cancer deaths, and major public health endeavours are justified to reduce this toll. Dietary factors may be as important, with dietary fat the most important risk factor, vegetables and fruits being protective. In several studies, including a cohort study in Canada, dietary fat increases breast cancer risk, though other studies have been negative. The evidence for fat increasing the risk of colorectal is more consistent. Epidemiology has shown that secondary prevention of cancer is applicable by screening for breast cancer with mammography with or without physical examination in women age 50–69, and screening for cervix cancer in women age 25–60 with cervical cytology. Organised screening programmes are essential to ensure that a high proportion of women are screened, and that the tests are high quality with adequate quality control. Under these circumstances screening every 2 years for breast cancer and every 3 years for cervix cancer is cost-effective. Screening for other cancers cannot be recommended currently. There is a time to effect that must be recognised in planning primary or secondary prevention. Full effect of most primary activities will not be achieved for decades, screening may require a decade. Available knowledge must be applied now, however, to ensure the effect will eventually be seen, as is now occurring in some countries with the downturn in lung cancer mortality following smoking reduction in men.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-7225
    Keywords: Canada ; cancer etiology ; case-control study ; cohort study ; dietary fiber ; vitamin A ; vitamin C ; vitamin E
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Risk of breast cancer was examined in relation to intake of dietary fiber and vitamins A, C, and E, and food groups which are sources of these dietary constituents, in a cohort of 56,837 women enrolled in the Canadian National Breast Screening Study. Between 1982 and 1987, 519 incident, histologically confirmed cases of breast cancer were identified among women who previously had completed self-administered dietary questionnaires. Their nutrient and food intake was compared with that of 1,182 women who had not developed breast cancer during the follow-up period. Women at the uppermost quintile level of dietary fiber intake had a 30 percent reduction in risk of breast cancer relative to that for women at the lowest quintile level (adjusted odds ratio = 0.68,95 percent confidence interval = 0.46–1.00), and the reduction in risk persisted after adjustment (separately) for total vitamin A, β-carotene, vitamin C, and α-tocopherol. Inverse associations of similar magnitude were observed in association with consumption of pasta, cereals (the trend for which was statistically significant), and vegetables rich in vitamins A and C. Smaller, statistically nonsignificant reductions in risk were observed with increasing intake of dietary retinol, β-carotene, and vitamin C, but the magnitude of these associations was reduced after adjustment for other dietary factors. Vitamin E intake was not associated with altered risk of breast cancer.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-7225
    Keywords: Canada ; diet ; benign breast disease ; breast cancer ; women
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A case-cohort analysis of the association between diet and risk of benign proliferative epithelial disorders (BPED) of the breast was undertaken within a cohort of 56,537 women who were enrolled in the Canadian National Breast Screening Study (NBSS) and who completed a self-administered dietary questionnaire. (The NBSS is a randomized controlled trial of screening for breast cancer in women aged 40 to 59 years.) BPED are thought to have premalignant potential. Specific hypotheses were that risk of BPED would increase with increasing energy-adjusted fat intake and decrease with increasing energy-adjusted vitamin A and fiber intake. Additionally, we explored the association between calcium intake and risk of BPED. During the active follow-up phase of the NBSS, 657 women in the dietary cohort were diagnosed with biopsy-confirmed incident BPED. For comparative purposes, a subcohort consisting of a random sample of 5,581 women was selected from the full dietary cohort. After exclusions for various reasons, the analyses were based on 545 cases and 4,921 non-cases. Overall, the results were almost uniformly null, and provided little support for the study hypotheses. Rate ratios (95 percent confidence intervals [CI]) for the highest cf the lowest quintile levels for total fat, retinol, β-carotene, fiber, and calcium were 0.88 (CI = 0.65-1.20), 0.97 (CI = 0.71-1.31), 0.94 (CI = 0.70-1.27), 1.11 (CI = 0.82-1.50), and 0.81 (CI = 0.60-1.07), respectively. There were too few cases of atypical BPED for meaningful analysis, but results for those whose BPED showed no atypia were similar to the overall results. Further analyses conducted separately in the screened and control arms of the NBSS also failed to provide strong support for dietary associations, as did those conducted separately for screen-detected and interval-detected BPED.
    Type of Medium: Electronic Resource
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