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  • 1
    Electronic Resource
    Electronic Resource
    Alcohol consumption and postmenopausal endometrial cancer: results from the Iowa Women's Health Study (1993)
    Springer
    Cancer causes & control 4 (1993), S. 323-329 
    Details
    ISSN: 1573-7225
    Keywords: Alcohol ; cohort study ; endometrial cancer ; estrogen replacement therapy ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: At least three case-control studies have examined the association between alcohol consumption and endometrial cancer; two studies showed inverse associations, and a third a positive association. To our knowledge, no prospective studies of this association have been reported. The association between alcohol and endometrial cancer was examined in the Iowa Women's Health Study (United States), a prospective study of postmenopausal women. Information on alcohol consumption and other variables was obtained through a mailed questionnaire in January 1986. Through December 1990, 167 incident endometrial cancer cases occurred in the at-risk cohort of 25,170 women. Multivariate-adjusted relative risks (RR) and 95 percent confidence intervals (CI) were computed using Cox proportional hazards regression controlling for age, body mass index (BMI), parity, age at menopause, and noncontraceptive estrogen use, and to determine multiplicative interactions. The RRs of endometrial cancer associated with 〈4.0 and ≥4.0 g of alcohol per day compared with abstainers were 0.7 (CI=0.5–1.1) and 1.0 (CI=0.7–1.6), respectively. No statistically significant association between endometrial cancer and consumption of either beer, wine, or liquor was observed. There was no interaction between alcohol and any other endometrial cancer risk factors, including BMI or noncontraceptive estrogen use. These data do not support an association between alcohol and endometrial cancer among postmenopausal women.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00051334
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  • 2
    Electronic Resource
    Electronic Resource
    Difficulty becoming pregnant and family history as interactive risk factors for postmenopausal breast cancer: the Iowa Women's Health Study (1993)
    Springer
    Cancer causes & control 4 (1993), S. 21-28 
    Details
    ISSN: 1573-7225
    Keywords: Breast neoplasms ; family history ; infertility ; Iowa Women's Health Study ; nulliparity ; prospective studies ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: We recently provided data from a prospective cohort study of postmenopausal women which suggested that a first livebirth at age 30 or older (cf before age 20) was associated with a twofold increased risk of breast cancer in women without a family history, but a 5.8-fold higher risk in women with a positive family history. To address the question of whether these observations reflect difficulty becoming pregnant or maintaining a pregnancy, we performed additional analyses in which the outcome of each pregnancy was considered. During five years of follow-up, 620 incident cases of breast cancer were identified in the 37,105 women at risk. There was little evidence for an increased risk associated with a history of spontaneous abortion (relative risk [RR]=1.1; 95 percent confidence interval [CI]=0.9–1.4), nor was the risk higher among women who reported two or more spontaneous abortions in consecutive pregnancies (RR=1.0, CI=0.7–1.4). Although women who reported that they had tried unsuccessfully to become pregnant had only slightly and nonsignificantly elevated risks of breast cancer (RR=1.1, CI=0.9–1.3), a more pronounced and statistically significant association was noted in women with a positive family history (RR=2.0, CI=1.4–3.2). There was a strong inverse association between failure to become pregnant and parity (P〈0.0001); nearly 50 percent of the nulliparous married women reported having tried and failed to become pregnant, whereas the frequency was only 6.8 percent among married women with five or more livebirths. Thus, difficulties in becoming pregnant may characterize a subset of women at increased risk of breast cancer, especially in the presence of a family history.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00051710
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  • 3
    Electronic Resource
    Electronic Resource
    Early body size and subsequent weight again as predictors of breast cancer incidence (Iowa, United States) (1995)
    Springer
    Cancer causes & control 6 (1995), S. 112-118 
    Details
    ISSN: 1573-7225
    Keywords: Breast cancer ; body mass index ; females ; United States ; weight gain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: We examined whether associations of adult weight gain with the risk of postmenopausal breast cancer vary by stature, waist-hip ratio (WHR), and early adult size in a cohort of 37,105 Iowa (United States) women. Both low body mass index (kg/m2) (BMI) at age 18 and high subsequent weight-gain were associated independently with increased risk of incident postmenopausal breast cancer. After stratifying on BMI at age 18, high weight gain was associated with increased risk irrespective of whether early BMI was low (relative risk [RR]=1.92, 95 percent confidence interval [CI]=1.45–2.53) or high (RR=1.59, Ci=1.19–2.12). Women with lower BMI at 18 were at a higher risk at all levels of weight change, but having low BMI at age 18 and low subsequent weight gain conferred no significantly excess risk over those with high BMI at 18 and low gain. An inconsistent increase in risk was associated with taller stature; there was no additional risk associated with high WHR. Part of the observed risk from lower early size may reflect greater weight gain by lighter women. Limiting adult weight gain thus may be a feasible method to avoid increasing an individual's risk of breast cancer. Reasons for different effects of early cf late weight gain are not established, but benefits of a greater size at age 18 are likely to be offset by increased risks of other weight-related diseases at older ages.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00052771
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  • 4
    Electronic Resource
    Electronic Resource
    Diet and risk of colon cancer in a large prospective study of older women: an analysis stratified on family history (Iowa, United States) (1998)
    Springer
    Cancer causes & control 9 (1998), S. 357-367 
    Details
    ISSN: 1573-7225
    Keywords: Colon cancer ; diet ; family history ; United States ; women
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The purpose was to investigate whether dietary associations with risk of colon cancer in women differ by family history of the disease. Methods: Data were analyzed from a prospective cohort study of 35,216 Iowa (United States) women aged 55 to 69 years at baseline. Through 31 December 1995, 241 colon cancers were identified through record linkage with the State Health Registry. The cohort was stratified on family history of colon cancer in first-degree relatives; nutrient intakes were divided into tertiles. Results: Analyses using Cox regression revealed that the association of most dietary components with colon cancer incidence were similar for individuals with and without a family history. However, total calcium intake was associated inversely with colon cancer among women with a negative family history (relative risk [RR]=0.50 for upper cf lower tertile, P 〈 0.001), but was unrelated to incidence for women with a positive family history (RR=1.1 for upper cf lower tertile, P=0.69). Similarly, total vitamin E intake was associated with lower risk among women with a negative family history (RR=0.67 for upper cf lower tertile, P=0.04), but not among women with a positive family history (RR=0.87 for upper cf lower tertile, P=0.67). High intakes of fiber, fruits, and vegetables were each weakly inversely associated with risk among family-history negative women, but not among family-history positive women. Conclusions: These data, if corroborated, suggest that dietary factors typically associated with lower risk may be less effective risk-reduction interventions against colon cancer for individuals with a family history of colon cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008886715597
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  • 5
    Electronic Resource
    Electronic Resource
    Genetic anticipation and breast cancer: a prospective follow‐up study (1999)
    Springer
    Breast cancer research and treatment 55 (1999), S. 21-28 
    Details
    ISSN: 1573-7217
    Keywords: age of diagnosis ; ascertainment ; breast cancer ; genetic anticipation ; prospective cohort family study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Genetic anticipation is characterized by an earlier age of disease onset, increased severity, and a greater proportion of affected individuals in succeeding generations. The discovery of trinucleotide repeat expansion (TRE) mutations as the molecular correlate of anticipation in a number of rare Mendelian neurodegenerative disorders has led to a resurgence of interest in this phenomenon. Because of the difficulties presented to traditional genetics by complex diseases, the testing for genetic anticipation coupled with TRE detection has been proposed as a strategy for expediting the identification of susceptibility genes for complex disorders. In the case of breast cancer, a number of previous studies found evidence consistent with genetic anticipation. It is known that a proportion of such families are linked to either BRCA1 or BRCA2, but no TRE mutations have been identified. It has been shown that the typical ascertainment employed in studies purporting to demonstrate genetic anticipation combined with unadjusted statistical analysis can dramatically elevate the type I error. We re‐examine the evidence for anticipation in breast cancer by applying a new statistical approach that appears to have validity in the analysis of anticipation to data ascertained from a recent follow‐up of a large prospective cohort family study of breast cancer. Using this approach, we find no statistically significant evidence for genetic anticipation in familial breast cancer. We discuss the limitations of our analysis, including the problem of adequate sample size for this new statistical test.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1006151132592
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  • 6
    Electronic Resource
    Electronic Resource
    Association of mammographically defined percent breast density with epidemiologic risk factors for breast cancer (United States) (2000)
    Springer
    Cancer causes & control 11 (2000), S. 653-662 
    Details
    ISSN: 1573-7225
    Keywords: breast cancer ; breast density ; mammographic density ; risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Mammographically defined percent breast density is an important risk factor for breast cancer, but the epidemiology of this trait is poorly understood. Although several studies have investigated the associations between reproductive factors and density, few data are available on the associations of breast density and waist-to-hip ratio (WHR), physical activity, education, alcohol and smoking. Methods: We investigated the associations of known and suspected breast cancer risk factors with breast density in a large breast cancer family study. Information was collected on members of 426 families through telephone interviews, mailed questionnaires and mammography. Mammographic films on 1900 women were digitized and breast density was estimated in discrete five-unit increments by one radiologist. Analysis of covariance techniques were used and all analyses were performed stratified by menopausal status. Results: Similar to other reports, nulliparity, late age at first birth, younger age and lower body mass index were associated with increased percent density in both premenopausal and postmenopausal women, and hormone replacement therapy among postmenopausal women. Higher levels of alcohol consumption and low WHR were associated with increased percent density among both premenopausal and postmenopausal women (differences of 3–11% between high and low categories). However, smoking and education were inversely associated with percent density among premenopausal (p = 0.004 and p = 0.003, respectively) but not postmenopausal women (p = 0.52 and p = 0.90). Physical activity was not associated with percent density in either stratum (p values 〉 0.25). Combined, these factors explained approximately 37% of the variability in the percent density measure in premenopausal women and 19% in postmenopausal women. Conclusions: Many of these factors may potentially affect breast cancer risk through their effect on percent breast density.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008926607428
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  • 7
    Electronic Resource
    Electronic Resource
    An investigation of the biological basis of an interaction of abdominal fat distribution and family history of breast cancer. A nested study of sisters in the Iowa Women's Health Study (United States) (2000)
    Springer
    Cancer causes & control 11 (2000), S. 941-954 
    Details
    ISSN: 1573-7225
    Keywords: adipose tissue ; breast neoplasms ; insulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The present study examined whether levels of testosterone, sex hormone binding globulin (SHBG), or insulin levels might underlie an increased risk of postmenopausal breast cancer in women with both high waist-to-hip ratio and a family history of breast cancer disease that was noted earlier in the Iowa Women's Health Study. Methods: Participants for the current study were selected from 1922 sister groups (3978 women) in the Iowa Women's Health Study cohort. Two groups were included: (1) those with no family history of breast cancer and at least one sister with a high waist-to-hip ratio; or (2) those with a positive family history of breast cancer and at least one sister with a high waist-to-hip ratio. Testosterone, SHBG and insulin were measured by radioimmunoassay from 245 fasting blood samples. Results: Familial correlations among members of 66 families were estimated at 0.32, 0.28 and 0.25 for serum insulin, free testosterone and SHBG; respectively. Fasting serum insulin was significantly higher in breast cancer family history negative women than in family history positive women, in direct opposition to our a priori hypothesis. No significant differences were observed in serum SHBG or free testosterone across family history categories. Conclusion: This study corroborates a genetic component to fasting serum insulin, free testosterone and SHBG levels. It seems unlikely that insulin, SHBG, or testosterone explain the interaction between waist-to-hip ratio and family history of breast cancer among participants in the Iowa Women's Health Study.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1026537819055
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  • 8
    Electronic Resource
    Electronic Resource
    Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States) (1994)
    Springer
    Cancer causes & control 5 (1994), S. 38-52 
    Details
    ISSN: 1573-7225
    Keywords: Anthropometry ; colonic neoplasms ; dietary fats ; females ; lifestyle ; meat ; prospective studies ; reproduction ; sucrose ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the relation of dietary intakes of sucrose, meat, and fat, and anthropometric, lifestyle, hormonal, and reproductive factors to colon cancer incidence, data were analyzed from a prospective cohort study of 35,215 Iowa (United States) women, aged 55–69 years and without a history of cancer, who completed mailed dietary and other questionnaires in 1986. Through 1990, 212 incident cases of colon cancer were documented. Proportional hazards regression was used to adjust for age and other risk factors. Risk factors found to be associated significantly with colon cancer included: (i) sucrose-containing foods and beverages other than ice cream/milk; relative risks (RR) across the quintiles=1.00, 1.73, 1.56, 1.54, and 2.00 (95% confidence intervals [CI] for quintiles two and five exclude 1.0); (ii) sucrose; RR across the quintiles=1.00, 1.70, 1.81, 1.82, and 1.45 (CI for quintiles two through four exclude 1.0); (iii) height; RR=1.23 for highest to lowest quintile (P for trend-0.02); (iv) body mass index; RR=1.41 for highest to lowest quintile (P for trend=0.03); and (v) number of livebirths, RR=1.59 for having had one to two livebirths and 1.80 for having had three or more livebirths compared with having had none (P for trend=0.04). These data support hypotheses that sucrose intake or being tall or obese increases colon cancer risk; run contrary to the hypothesis that increased parity decreases risk; support previous findings of no association with demographic factors other than age, cigarette smoking, or use of oral contraceptives or estrogen replacement therapy; and raise questions regarding previous associations with meat, fat, protein, and physical activity.Cancer Causes and Control 1994, 5, 38–52.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01830725
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  • 9
    Electronic Resource
    Electronic Resource
    Dietary cholesterol, fat, and lung cancer incidence among older women: The Iowa Women's Health Study (United States) (1994)
    Springer
    Cancer causes & control 5 (1994), S. 395-400 
    Details
    ISSN: 1573-7225
    Keywords: Cholesterol ; cohort study ; diet ; fat ; lung cancer ; nutrition ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To test the hypothesis that a high intake of dietary cholesterol and fat is associated with elevated risks of lung cancer, we analyzed data from a population-based, prospective, cohort study conducted among 41,837 postmenopausal Iowa (United States) women who completed, in 1986, a comprehensive mailed questionnaire including information on usual intake of 127 food items. All cohort members were followed for cancer incidence through the statewide cancer registry. By 1991, after six years of follow-up, 272 incident lung-cancer cases were identified. After controlling for total energy intake and other confounding factors, dietary cholesterol, total fat, and animal fat were unrelated to lung cancer risk. Intake in the upper three quartiles of plantderived fat, however, was related to a 30 to 40 percent lower incidence of lung cancer, compared with those in the lowest quartile, with more pronoucned reduction in risk observed among smokers (relative risk=0.6, 95 percent confidence interval=0.4–0.9). This prospective cohort study suggests that high intake of fat of plant origin may be associated with reduced risk of lung cancer, while dietary cholesterol and animal fat intake is unrelated to the etiology of this malignancy in postmenopausal women.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01694752
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  • 10
    Electronic Resource
    Electronic Resource
    Perception of Genetic Risk Among Genetic Counselors (2000)
    Springer
    Journal of genetic counseling 9 (2000), S. 47-59 
    Details
    ISSN: 1573-3599
    Keywords: Risk perception ; prenatal diagnosis ; genetic counselor attitudes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Psychology
    Notes: Abstract A mailed survey of female prenatal genetic counselors, obstetric nurses, and high school biology teachers was conducted to determine if these groups hold different attitudes toward genetic risk and to investigate the extent to which any differences result from the effect of different professional experiences. In this study, the participants were 166 genetic counselors, 116 obstetric nurses, and 78 biology teachers (n = 360). Survey participants completed a written questionnaire designed to assess their numeric estimate of the empiric risk for birth defects/genetic problems, their subjective perception of this risk, and their personal use of prenatal diagnosis. Genetic counselors were found to be less likely than the other groups to consider the frequency of birth defects/genetic problems as rare and were 10 times more likely than nurses and 8 times more likely than teachers to have had prenatal diagnosis. Furthermore, more than half of the prenatal diagnosis procedures had by genetic counselors were not medically indicated. These results suggest that genetic counselors have an increased perception of genetic risks relative to nurses or teachers. Possible explanations for this finding are discussed, and the potential role of discordant risk perception in creating biases in the genetic counseling process is explored.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009481123596
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