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Notes: Aims. The aim of this paper was to examine the association between reporting childhood sexual abuse (CSA) and alcohol abuse in a community sample of women using multivariate analysis which took into account a range of potential confounding variables (such as a family history of alcoholism) and effect modifiers (such as having an alcoholic partner). Design. A two-stage retrospective case-control study was used to investigate the relationship between reporting CSA and alcohol abuse in women. Participants. Seven hundred and ten women randomly selected from the Australian federal electoral rolls. Measurements. The Alcohol Use Disorders Identification Test (AUDIT) was used to measure alcohol abuse. A series of questions based on those developed by Wyatt (1985) were used to ascertain the prevalence of CSA. Findings. The final model showed that the relationship between a history of CSA and alcohol abuse reflected a complex interaction between CSA and a range of other factors in a woman's background. CSA was not by itself a significant predictor of alcohol abuse (OR = 0.61; 95% CI = 0.31-1.20). However, a history of CSA became significant in combination with co-factors which included: having a mother who was perceived as cold and uncaring; having an alcoholic partner; and believing that alcohol is a sexual disinhibitor. Conclusion. This study indicates that CSA alone is not a causative factor in the development of alcohol abuse among women and highlights the importance of examining the family background of women with alcohol problems.

Notes: Summary A chemical plant, where an increased number of non-Hodgkin's lymphomas and myelomas had been observed, was monitored for genotoxic effects occurring in peripheral mononuclear leukocyte samples from 76 exposed workers. Biochemical markers sensitive to DNA repair and drug metabolism were used as the indicators of genotoxic risk. Unscheduled DNA synthesis (UDS) and covalent binding induced by N-acetoxy-N-acetyl-2-aminofluorene (NA-AAF) and constitutive and gamma ray induced adenosine diphosphate ribosyl transferase (ADPRT) activities were highly and significantly elevated over the corresponding values for a control group of 48 postal workers. Microsomal and soluble epoxide hydrolases and glutathione transferase activities directed towards trans-stilbene oxide and 1-chloro-2,4-dinitrobenzene were not significantly altered in the exposed group. The exposure in this factory was complex, involving over 100 chemicals including several well known carcinogens. However, no apparent significant associations to exposure could be established.

Notes: Summary Eighty-five workers in a chemical plant, in which there was an increased frequency of B-lymphocyte tumours (myelomas and lymphomas) and lung cancer, did not excrete higher amounts of thioethers in urine than 48 control subjects. The chemically exposed workers had, however, a higher excretion of thioethers in urine during shift compared to an exposure-free period. The bacterial fluctuation test showed a statistically significantly increased mutagenic activity for E. coli Wp2 uvrA, but not for Salmonella TA98, in the urine of the exposed workers compared with the controls. However, no difference in excretion was found in the chemical workers between work and an exposure free-period. Further, no association of thioether or mutagen excretion with any specific chemical exposure (e.g. ethylene oxide and formaldehyde) in the plant could firmly be established.

Notes: Summary A hypothesis that selenium deficiency predisposes the development of occupational cervicobrachial complaints was tested in 134 females working in an assembly factory, with constrained work postures and repetitive work tasks. Seventeen subjects, who reported intake of selenium tablets, had higher plasma selenium levels than the others (104 vs 89 μg/l, P = 0.01). Among those who did not take selenium tablets, 21% reported symptoms from the upper back during the last 7 d, 21% from the neck, 38% from the shoulders, 15% from the elbows, and 27% from the hands. Subjects with pain in their elbows had slightly, but significantly, lower plasma selenium levels than asymptomatics (84 vs 90 μg/l, P = 0.048). For the other anatomical regions, there were no statistically significant differences. Thus, there was no major association between selenium status and pain; conclusions regarding any minor association must await further studies.

Notes: Summary To evaluate the risk of non-malignant respiratory disease and tumours at exposure to sulphur dioxide, a retrospective cohort study was performed on a group of 400 male workers, employed for at least six months during the period 1961–1981, in a sulphuric acid factory. Since 1969, fairly extensive measurements have been performed in the respiratory zone of the workers. The median level of total dust, over the years, was 2.2 mg/m3 (time-weighted average), of respirable dust 0.6 mg/m3, of sulphur dioxide 3.6 mg/m3, and of arsenic 11 μg/m3. There was a significantly increased total mortality in the period 1961–1985. Applying ≥ 5 years latency period there were 47 observed deaths, giving a standardized mortality rate (SMR) of 1.57 (P = 0.002). The increased mortality was due to violence and intoxication (observed 9, SMR = 2.83; P = 0.006) and cardiovascular disease (SMR = 1.51, P = 0.05). The total tumour morbidity was not increased (observed 17, SMR = 1.17, P 〉 0.5) and there was no rise of either non-malignant or malignant lung diseases. However, there was an increase of bladder cancer (observed 5, SMR = 4.36, P = 0.006).

Notes: Summary A cohort of 2,131 male nitrate fertilizer workers was evaluated for cancer morbidity from 1963 to 1986. No significant increase in total cancer, stomach cancer (5 actual vs 6.7 expected cases), or lung cancer (13 vs 13 expected) was found. On the other hand, 26 actual cases of prostate cancer were observed vs 16 expected cases (standardized morbidity ratio, SMR = 161; 95%, confidence interval, CI = 107–239). This risk increase however, was, not enhanced by applying at least a 10-year latency period. In a cohort of 1,148 male fertilizer workers who had never been exposed to nitrate, there was an increased incidence of lung cancer (SMR = 151,95% CI = 103–220) but not of stomach cancer or prostate cancer. There was no association between airborne nitrate exposure dose and total cancer, stomach cancer, lung cancer or prostate cancer, respectively.

Notes: Summary In order to investigate possible effects of exposure to pesticides, mainly fungicides and insecticides, we studied a cohort of 2370 subjects, who, during the period 1965–1982, had been members of a horticulturists' trade association (market gardeners and orchardists). Compared to a regional reference population, total mortality (542 deaths; standardized mortality morbidity ratio, SMR = 0.8; 95% confidence limits, CLs = 0.7, 0.9) and mortality due to malignant tumours (133 deaths, SMR = 0.9; CLs = 0.7, 1.0), and cardiovascular and respiratory deaths were somewhat decreased. Suggestive excesses in mortality were seen for mental disorders and tumours of the stomach, skin and nervous system. The tumours of the nervous system were in particular excess in the young and middle-aged horticulturists (below age 60; six cases, SMR = 2.9; CLs = 1.1, 6.2). During the period 1965–1986, the total tumour morbidity was slightly decreased (255 cases; SMR = 0.9; CLs = 0.8, 1.0), as were gastro-intestinal and respiratory tract tumours. The incidence of melanomas was increased (15 cases, SMR = 2.1; CLs = 1.2, 3.5), and tumours of the female genital organs, myelomas, and brain tumours (12 cases, SMR = 1.5; CLs = 0.8, 2.7) were slightly numerically elevated. Brain tumours in the young and middle-aged horticulturists (11 cases, SMR = 3.2; CLs = 1.6, 5.7), including meningiomas (four observed, SMR = 6.8; CLs = 1.9, 17.4), were increased, especially in the period 1975–1979. The mortality and tumour morbidity patterns in gardeners and orchardists, analysed separately, were similar to the patterns in all the horticulturists. The risk for brain tumours in the young and middle-aged subjects was increased about threefold in the gardeners, and about fivefold in the orchardists; in particular, meningiomas were in excess among the gardeners.

Notes: Summary Cancer morbidity was investigated in a cohort of 2,170 ethylene oxide (EO)-exposed workers from 2 plants producing disposable medical equipment. The subjects had been employed for at least 1 year during the periods 1970–1985 and 1964–1985, respectively. The exposure to EO was assessed for each of six job categories in the plants with respect to each calendar year, on which basis values for individual cumulative exposure to EO (ppm-years) were calculated. The levels of hydroxyethyl adducts to N-terminal valine (HOEtVal) in hemoglobin fitted well with the values estimated for airborne exposure to EO. No increased cancer incidence was found [standardized morbidity ratio (SMR), 0.78; 95% CI, 0.49–1.21)]. No leukemia was observed, but one case No leukemia was observed, but one case of non-Hodgkin's lymphoma, one case of myeloma, and one case of polycythemia vera were diagnosed as compared with two expected hematopoietic and lymphatic tumors (SMR, 1.54; 95% Cl, 0.32–4.5). No stomach cancer was detected as compared with the 0.5 case expected. There were no significant exposure-response associations between estimates of exposure to EO and cancer morbidity.

Notes: Abstract In a prospective study of a consecutive breast cancer series accumulated in the period 1978–82, the S-phase fraction (SPF) and ploidy status were determined by flow cytometry performed on cell nuclei derived from samples of 580 primary tumors. Sixty percent of the tumors were non-diploid. After correction for debris the median SPF values were 7.3% overall, 12% for non-diploid tumors, and 2.9% for diploid tumors (2.6% when nodal subsets N2 and N3 and cases with metastases at presentation were excluded). The SPF values correlated both to tumor size (p=0.008) and to the number of positive axillary lymph nodes (p=0.03). At clinical follow-up in 1986, 467 unilateral breast cancer patients who had undergone radical treatment for cure could be evaluated with respect to the prognostic value of both the SPF value and ploidy status. The median duration of follow-up was then 59 months (range 2–90), and the median time-to-recurrence 24 months (range 2–69, n=137). At follow-up in 1991, 201/467 of the patients had died, the median duration of follow-up being 50 months (range 2–126) for the deceased, and 119 (range 6–148) for the survivors. In multivariate analysis (Cox's proportional hazards models), the strongest independent predictors of distant recurrence-free survival (DRFS) were the number of positive axillary lymph nodes (p〈0.0001), the debris-corrected SPF value alone (p=0.003,versus p=0.05 for uncorrected value), and ploidy status combined with the corrected SPF value (p=0.0002). When age was taken into account, both the corrected SPF value and the ploidy-SPF combination were predictors of crude survival (p=0.006 and p=0.002, respectively). In univariate life-table analysis, the 5-year DRFS rate was 93% in node-negative (N0) cases with an SPF〈7.3%, as compared to 80% in those with an SPF≥7.3% (p=0.005). Among node-positive cases, the prognostic value of the SPF was confined to those with 1–3 positive nodes, the 5-year DRFS rate being 68% in cases with an SPF〈7.3%, as compared to 40% in cases with an SPF≥7.3% (p=0.01). Ploidy status and SPF were combined to form four groups: diploid & SPF〈2.6% (DL), diploid & SPF≥2.6% (DH), non-diploid & SPF〈12% (NDL), and non-diploid & SPF≥12% (NDH). Among node-negative patients, the DRFS rate fell from 95% in the DL group to 87% in the NDL group, with the DH group at an intermediate level, as compared with 74% (p=0.03) for the NDH group which accounted for the bulk of the early distant recurrences. Among patients with 1–3 positive lymph nodes, the 5-year DRFS rate was 68% in both the groups with low SPF values (DL and NDL), as compared with 45% in the DH group (p=0.03), and 37% in the NDH group (p=0.006). In this study, the flow cytometry SPF value, alone or in combination with ploidy status, yielded the most profound additional prognostic information, enabling both node-negative patients with a high probability of cure and patients at risk of early relapse to be identified. Among node-positive patients, the prognostic value of the SPF value was confined to those with 1–3 positive axillary lymph nodes (the predominant node-positive subgroup), enabling a high and a low DRFS rate subgroup to be distinguished – a useful distinction where selection for adjuvant drug treatment is concerned. As the predictive strength of the SPF value was enhanced when correction was made for debris, we would recommend that the effect of such factors as debris be minimized as far as possible when flow cytometry-derived SPF values are to be used for prognostic purposes.

Notes: Summary The prospective prognostic significance of flow cytometry derived DNA-ploidy status, the level of the S-phase fraction (SPF), estrogen receptor (ER) content, and combinations of these factors, was evaluated with respect to overall survival (OS) in a series of 516 breast cancer patients who were without signs of residual or distant disease after primary completed treatment. The median duration of survival follow-up time was ten years (range, 95–148 months) for surviving patients. Of the single factors, ER was the only significant predictor among node-negative patients; the ten-year OS rate was 71% in cases with ER-rich tumors vs. 62% for ER-poor tumors (p=0.03). Where tumors were both non-diploid and ER-poor, the ten-year OS rate was 58%, as compared to 75% for the remaining node-negative patients (p=0.003), who constituted a low-risk group whose survival was comparable with that in the age-matched normal population. Among patients with 1–3 positive nodes, the ten-year OS rate was 65% in patients whose tumors had an SPF 〈7.3% vs. 50% if the SPF was ≥7.3% (p=0.01), and 58% in cases with ER-rich tumors vs. 45% where the tumors were ER-poor (p=0.02). In a multivariate analysis, apart from age and menopausal status the combination of ploidy status and ER content was the significant (p=0.002) predictor of OS in node-negative patients. Thus, combining ploidy and ER status, both of which are variables easily determined, enabled the selection of a subgroup of patients at high risk of relapse and reduced survival whose prognosis should be improved by effective adjuvant systemic treatment, whereas the remaining low risk N0 patients can not be expected to derive any survival benefit from adjuvant therapy since their predicted survival is already on a par with that of the general population.