Carol A. Janney

The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphoma: A surveillance, epidemiology, and end results analysis

Primary central nervous system lymphoma (PCNSL) is an extranodal form of non‐Hodgkin lymphoma arising in the craniospinal axis. The incidence of PCNSL appears to be increasing.

Age-specific Trends in Mammographic Density The Minnesota Breast Cancer Family Study

Mammographic density is a strong risk factor for breast cancer, yet few studies have evaluated density trends, and associated factors, over time. The authors retrieved and digitized mammograms (> or =1 per woman) imaged in 1990-2003 to evaluate percent density (PD) in the Minnesota Breast Cancer Family cohort. Multivariable-adjusted, mixed-effects, repeated-measures models incorporating a natural cubic spline provided estimates of nonlinear trends in PD with age and were used to examine association with covariates. Overall, 5,698 mammograms from 1,689 women with covariate information were digitized. In descriptive analyses, the highest median PD was 33.1% (interquartile range, 21.8%; n = 230) among premenopausal women, 31.0% (interquartile range, 23.2%; n = 175) among women who transitioned from pre- to postmenopause, and 18.7% (interquartile range, 22.2%; n = 1,284) among postmenopausal women. On average, premenopausal compared with postmenopausal women had 1.9% (p = 0.001) higher PD. In repeated-measures analyses, greater declines in PD occurred with menopause and among women with higher baseline PD; current postmenopausal hormone use and higher body mass index modified these declines (p interaction < 0.001). No significant modification of the density change with age was seen with parity/age at first birth, age at menarche, oral contraceptive use, family history of breast or ovarian cancer in a first- or second-degree relative, educational level, smoking status, or alcohol intake were observed. These data suggest that menopause, baseline PD, postmenopausal hormone use, and body mass index predict changes in mammographic density trends during adult life.

Association of aspirin and other non-steroidal anti-inflammatory drug use with incidence of non-Hodgkin lymphoma

Non‐steroidal anti‐inflammatory drugs (NSAIDs), including aspirin, seem to have chemopreventive properties against several types of cancer, particularly colon cancer. Persons with rheumatoid arthritis, an autoimmune disease for which NSAIDs are used commonly, have been reported to be at lower risk of colon cancer but at elevated risk of non‐Hodgkin lymphoma (NHL), raising the possibility that NSAIDs may be a risk factor for NHL. We evaluated the association of use of NSAIDs, arthritis history, and risk of NHL in a prospective cohort of 27,290 postmenopausal women from the state of Iowa. The frequency of use of aspirin and of other NSAIDs excluding aspirin (e.g., ibuprofen), as well as a physician diagnosis of rheumatoid arthritis (RA) or osteoarthritis (OA), were self‐reported on a questionnaire mailed in 1992. The incidence of NHL was ascertained through annual linkages to the Iowa SEER Cancer Registry. Relative risks (RR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. Through 7 years of follow‐up, 131 cases of NHL were identified. Compared to women who did not use either aspirin or other non‐aspirin NSAIDs, women using aspirin exclusively (RR = 1.71; 95% CI = 0.94–3.13), non‐aspirin NSAIDs exclusively (RR = 2.39; 95% CI = 1.18–4.83), or both types of drugs (RR = 1.97; 95% CI = 1.06–3.68) were at increased risk of NHL. A diagnosis of RA (RR = 1.75; 95% CI = 1.09–2.79), but not OA (RR = 1.06; 95% CI = 0.67–1.68), was associated with risk of NHL, but the positive association of use of aspirin and other NSAIDs with NHL was independent of RA history. Multivariate adjustment for other NHL risk factors only attenuated slightly these associations, whereas exclusion of cases occurring during the first 2 years of follow‐up strengthened the associations. These data suggest that use of NSAIDs, either aspirin or other non‐aspirin NSAIDs, are associated positively with risk of NHL, and that this association is independent of RA history.

Smoking Cessation and Renal Cell Carcinoma

PURPOSE The magnitude and timing of the reported decrease in risk of renal cell carcinoma (RCC) attributed to smoking cessation is not well characterized. Furthermore, conclusions from previous investigations have been hampered by unstable risk estimates, broad exposure categories and/or insufficient adjustment for the inverse correlation of cessation years with lifetime smoking exposure. METHODS To address these issues, we report data from a population-based case-control study conducted in Iowa from 1986 to 1989. RCC cases (n = 387) were identified through the Iowa Cancer Registry, while controls (n = 2,333) were randomly selected from the general population, frequency-matched on age and sex. Subjects provided detailed information on a mailed questionnaire regarding their smoking history as well as other anthropometric, lifestyle, dietary and medical history risk factors. RESULTS Smoothing spline regression analysis provided evidence of a consistent inverse linear trend between years of cessation and risk of RCC. In categorical analysis, compared with current smokers, those quitting > or =30 years ago experienced a 50% reduction in risk of RCC (OR = 0.5; 95% CI 0.3 to 0.8) after adjustment for age, sex, BMI, hypertension and pack-years of smoking. Risk among long-term quitters was similar to risk among never smokers (OR = 0.6; 95% CI 0.4 to 0.8). In contrast, cessation of <10 years, 10 to 19 years and 20 to 29 years all resulted in a less pronounced reduction in RCC risk ( approximately 20% to 30%). CONCLUSIONS Our findings suggest that while cessation of smoking is indeed associated with a linear decrease in RCC risk even after adjustment for potential confounders, this benefit may not be sizeable until more than 20 years following cessation.

Prenatal and Perinatal Correlates of Adult Mammographic Breast Density

Background: Adult mammographic percent density is one of the strongest known risk factors for breast cancer. In utero exposure to high levels of endogenous estrogens (or other pregnancy hormones) has been hypothesized to increase breast cancer risk in later life. We examined the hypothesis that those factors associated with higher levels of estrogen during pregnancy or shortly after birth are associated with higher mammographic breast density in adulthood. Methods: We analyzed data on 1,893 women from 360 families in the Minnesota Breast Cancer Family Study who had screening mammograms, risk factor data, over age 40, and no history of breast cancer. Prenatal and perinatal risk factor data were ascertained using a mailed questionnaire. Mammographic percent density and dense area were estimated from the mediolateral oblique view using Cumulus, a computer-assisted thresholding program. Linear mixed effects models incorporating familial correlation were used to assess the association of risk factors with percent density, adjusting for age, weight, and other breast cancer risk factors, all at time of mammography. Results: The mean age at mammography was 60.4 years (range, 40-91 years), and 76% were postmenopausal. Among postmenopausal women, there was a positive association of birthweight with percent density (P trend <0.01), with an adjusted mean percent density of 17.1% for <2.95 kg versus 21.0% for ≥3.75 kg. There were suggestive positive associations with gestational age (mean percent density of 16.7% for preterm birth, 20.2% for term birth, and 23.0% for late birth; P trend = 0.07), maternal eclampsia/preeclampsia (mean percent density of 19.9% for no and 14.6% for yes; P = 0.16), and being breast-fed as an infant (mean percent density of 18.2% for never and 20.0% for ever; P = 0.08). There was no association of percent density with maternal age, birth order, maternal use of alcohol or cigarettes, or neonatal jaundice. Except for being breast-fed, these associations showed similar but attenuated trends among premenopausal women, although none were statistically significant. The results for dense area paralleled the percent density results. The associations of gestational age and being breast-fed as an infant with percent density attenuated when included in the same model as birthweight. Conclusions: Birthweight was positively associated with mammographic breast density and dense area among postmenopausal women and more weakly among premenopausal women, suggesting that it may be a marker of this early life exposure. These results offer some support to the hypothesis that pregnancy estrogens or other pregnancy changes may play a role in breast cancer etiology, and suggest that these factors may act in part through long-term effects on breast density.

Complementary and alternative medicine use among long‐term lymphoma survivors: A pilot study

No published survey has specifically addressed the beliefs, knowledge, and usage of complementary and alternative medicine (CAM) in long‐term (5–20 years) lymphoma survivors alone. In this pilot project, 95 subjects were randomly selected from a population of 2,475 long‐term lymphoma survivors and mailed a questionnaire. The median time from lymphoma diagnosis to completion of the questionnaire was 11 years (range 6–20). Overall, 68% (95% CI: 54–80%) of the long‐term lymphoma survivors reported that they have used CAM, a rate higher than the estimated usage rate reported for the general population The most commonly used modalities were chiropractic (39%, 95% CI: 27–53%) and massage therapy (21%, 95% CI: 12–34%). Less than 10% used meditation (5%, 95% CI: 1–15%) and relaxation (7%, 95% CI: 2–17%). In terms of common herbal usage, 5% (95% CI: 1–15%) had used St. Johns Wort and 7% (95% CI: 2–17%) had used shark cartilage. Although none of the patients reported that CAM usage was directed specifically towards treating their lymphoma, 4% (95% CI: 0–12%) of patients reported that CAM could cure cancer, and 14% (95% CI: 6–26%) reported that CAM could increase their feeling of control over their health. This pilot study suggests that long‐term lymphoma survivors appear to use CAM at a rate higher than the general population. The use of potential agents of risk by the survivors and the lack of access to potentially beneficial modalities highlights the need for further study of CAM in this population. Am. J. Hematol., 2009.

The Association of Alcohol Consumption with Coronary Heart Disease Mortality and Cancer Incidence Varies by Smoking History

OBJECTIVE: To evaluate the effect of alcohol on coronary heart disease (CHD), cancer incidence, and cancer mortality by smoking history.DESIGN/SETTING: A prospective, general community cohort was established with a baseline mailed questionnaire completed in 1986.PARTICIPANTS: A population-based sample of 41,836 Iowa women aged 55–69 years.MEASUREMENTS: Mortality (total, cancer, and CHD) and cancer incidence outcomes were collected through 1999. Relative hazard rates (HR) were calculated using Cox regression analyses.MAIN RESULTS: Among never smokers, alcohol consumption (≥14 g/day vs none) was inversely associated with age-adjusted CHD mortality (HR, 0.40; 95% confidence interval [CI], 0.19 to 0.84) and total mortality (HR, 0.71; 95% CI, 0.55 to 0.92). Among former smokers. alcohol consumption was also inversely associated with CHD mortality (HR, 0.45; 95% CI, 0.23 to 0.88) and total mortality (HR, 0.78; 95% CI, 0.62 to 0.97), but was positively associated with cancer incidence (HR, 1.25; 95% CI, 1.03 to 1.51). Among current smokers, alcohol consumption was not associated with CHD mortality (HR, 1.05; 95% CI, 0.73 to 1.50) or total mortality (HR, 1.07; 95% CI, 0.92 to 1.25), but was positively associated with cancer incidence (HR, 1.30; 95% CI, 1.10 to 1.54).CONCLUSIONS: Health behavior counseling regarding alcohol consumption for cardioprotection should include a discussion of the lack of a decreased risk of CHD mortality for current smokers and the increased cancer risk among former and current smokers.

Association of parity and ovarian cancer risk by family history of breast or ovarian cancer in a population-based study of postmenopausal women

Although parity is associated with a decreased risk of ovarian cancer in the general population, this association among women with a family history is less clear. We examined this question in a prospective cohort of 31,377 Iowa women 55–69 years of age at baseline. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated through Cox regression. We identified 181 incident epithelial ovarian cancers through 13 years of follow-up. At baseline, 14% of the women reported breast or ovarian cancer in a first-degree relative, and an additional 12% reported a family history in a second-degree relative. Among women without a family history of breast or ovarian cancer in a first-degree relative, nulliparous women were at slightly increased risk of ovarian cancer (RR = 1.4, 95% CI = 0.9–2.4) compared with parous women, whereas among women with a family history, nulliparous women were at a much higher risk (RR = 2.7, 95% CI = 1.1–6.6) than parous women. Similar results were seen when family history included first- or second-degree relatives with breast or ovarian cancer or a first- or second-degree relative with ovarian cancer only. Nulliparity may be more strongly associated with an increased risk of ovarian cancer among women with a family history of breast or ovarian cancer, compared with women who do not have a family history of those cancers.

Alcohol intake in adolescence and mammographic density

Adolescent exposures may be important in the development of breast cancer later in life. We examined the association of adolescent alcohol consumption and adult mammographic density, a strong risk factor for breast cancer. Women within the Minnesota Breast Cancer Family Cohort with detailed mammogram and risk factor information (n = 1,893) formed our sample. Breast cancer cases were excluded. Adolescent alcohol consumption (before age 18) was solicited through a mailed questionnaire. Percent density (PD) was estimated using the computer‐assisted thresholding program, Cumulus. Statistical analyses were performed using linear mixed effect models. Women who reported ever drinking alcohol before age 18 (n = 390; 21%) had a higher unadjusted PD than women who never drank during adolescence (

Adult daughters' reports of breast cancer risk reduction and early detection advice received from their mothers: an exploratory study.

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