Carol A. Rosenberg

Hypomastia and Mitral-Valve Prolapse: Evidence of a Linked Embryologic and Mesenchymal Dysplasia

THE pathogenesis of mitral-valve prolapse is unclear. However, it has been associated with thoracoskeletal abnormalities,1 , 2 connective-tissue disorders,3 4 5 and coagulopathies.6 Affected tissue...

Daily coffee consumption and prevalence of nonmelanoma skin cancer in Caucasian women

The purpose of this study was to assess the relationship between daily coffee consumption and nonmelanoma skin cancer. This study was a cross-sectional analysis of women enrolled in the Womens Health Initiative Observational Study (n=93 676). As nearly all cases of self-reported nonmelanoma skin cancer occurred among Caucasian women (97.8%), we focused our analyses on this group. Compared with nondrinkers, women drinking only caffeinated coffee on a daily basis had a 10.8% lower prevalence of nonmelanoma skin cancer. Consumption of six or more cups of caffeinated coffee per day was associated with a 36% reduction in nonmelanoma skin cancer. After adjusting for various demographic and life style variables, daily consumption of six or more cups was associated with a 30% reduced prevalence of nonmelanoma skin cancer. In contrast to caffeinated coffee, daily consumption of decaffeinated coffee was not associated with a significant change in self-reported nonmelanoma skin cancer for Caucasian women. Daily caffeinated coffee consumption was associated with a dose-related decreased prevalence of nonmelanoma skin cancer in Caucasian women.

Prospective analysis of association between use of statins or other lipid-lowering agents and colorectal cancer risk

PURPOSE To determine whether 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) are associated with a decreased risk of colorectal cancer. METHODS The population included 159,219 postmenopausal women enrolled in the Womens Health Initiative in which 2000 pathologically confirmed cases of colorectal cancer were identified during an average of 10.7 (S.D. 2.9) years. Information on statins was collected at baseline and years 1, 3, 6, and 9. Self- and interviewer-administered questionnaires were used to collect information on other risk factors. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by the use of Cox proportional hazards regression to evaluate the relationship between statin use and risk. Statistical tests were two-sided. RESULTS Statins were used by 12,030 (7.6%) women at baseline. The annualized colorectal cancer rate was 0.13% among users and 0.12% among nonusers. The multivariable adjusted HR for users versus nonusers was 0.99 (95% confidence interval [CI], 0.83-1.20, p = .95), and 0.79 (95% CI, 0.56-1.11) for users of ≥3 years. In the multivariable adjusted time-dependent model, the HR for lovastatin was 0.62 (95% CI, 0.39-0.99). There was no effect of tumor location, stage or grade. CONCLUSIONS There was a reduction in colorectal cancer risk associated with lovastatin and a nonsignificant association with longer duration of use.

Prospective analysis of association between statin use and breast cancer risk in the women's health initiative.

Background: Statins are a class of cholesterol-lowering drugs that affect many intracellular pathways that may have implications for chemoprevention against cancer. Epidemiologic data on statins and breast cancer are conflicting. We analyzed updated data from the Womens Health Initiative (WHI) to assess the relationship between statins and breast cancer risk. Methods: The population included 154,587 postmenopausal women ages 50 to 79 years, with 7,430 pathologically confirmed cases of breast cancer identified over an average of 10.8 (SD, 3.3) years. Information on statins was collected at baseline and years one, three, six, and nine. Self- and interviewer-administered questionnaires were used to collect information on risk factors. Cox proportional hazards regression was used to calculate HRs with 95% confidence intervals (CI) to evaluate the relationship between statin use and cancer risk. Statistical tests were two-sided. Results: Statins were used by 11,584 (7.5%) women at baseline. The annualized rate of breast cancer was 0.42% among statin users and 0.42% among nonusers. The multivariable adjusted HR of breast cancer for users versus nonusers was 0.94 (95% CI, 0.83–1.06). In the multivariable-adjusted, time-dependent model, the HR for simvastatin was 0.87 (95% CI, 0.71–1.07). There was no significant trend by overall duration of use (P value for trend 0.68). There was no effect of tumor stage, grade, or hormone receptor status. Conclusion: Overall, statins were not associated with breast cancer risk. Impact: Our study is one of the largest prospective observational studies on this topic, and substantially adds to the literature suggesting no relationship between statins and breast cancer risk. Cancer Epidemiol Biomarkers Prev; 22(10); 1868–76. ©2013 AACR.

Incident Invasive Breast Cancer, Geographic Location of Residence, and Reported Average Time Spent Outside

There have been reports of greater breast cancer incidence and mortality at northern compared with southern latitudes postulated to be related to vitamin D exposure. Among 71,662 participants in the Womens Health Initiative Observational Study (WHIOS) free of cancer at baseline (1993-1998), associations were explored between incident invasive postmenopausal breast cancer (n = 2,535), over ∼8.6 years follow-up, and the following: (a) region of residence at birth, age 15 years, age 35 years; (b) region of residence at WHIOS baseline; and (c) clinic center solar irradiance. Hazard ratios and 95% confidence intervals (CI) for breast cancer were estimated after adjustment for individual level confounders. There was no difference in breast cancer risk by region of earlier life, baseline residence, or solar irradiance measured in Langelys (gm-cal) per cm2. There was an observed 15% decreased risk among women residing in areas of low versus high solar irradiance measured in Watts per m2 (95% CI, 2-26%). However, the associated Ptrend of 0.20 was not significant. Conversely, women who reported spending on average <30 minutes versus >2 hours outside in daylight year round at WHIOS year 4 follow-up (n = 46,926), had a 20% (95% CI, 2-41%; Ptrend = 0.001) increased risk of breast cancer. In conclusion, region of residence and geographic solar irradiance are not consistently related to risk of breast cancer and may not be sufficient proxy measures for sunlight/vitamin D exposure. The observed association between time spent outside and breast cancer risk support the hypothesis that vitamin D may protect against breast cancer. (Cancer Epidemiol Biomarkers Prev 2009;18(2):495–507)

Prospective analysis of association between use of statins and melanoma risk in the Women's Health Initiative

Melanoma is the most lethal form of skin cancer, with an estimated 68,130 new cases and 8700 deaths in the United States in 2010. The increasing incidence and high death rate associated with metastatic disease support the need to focus on prevention. The authors used data from the Womens Health Initiative (WHI) to assess whether 3‐hydroxy‐3 methylglutaryl coenzyme A inhibitors (statins) are associated with a decreased risk of melanoma.

Prospective analysis of association between use of statins or other lipid-lowering agents and melanoma risk in the Women’s Health Initiative.

1586 Background: Melanoma is the most lethal form of skin cancer with an estimated 68,130 new cases diagnosed and 8700 deaths in 2010. The rapidly increasing incidence of melanoma and the high death rate associated with advanced or metastatic disease support the need to focus on prevention as a way to reduce both incidence and mortality. We utilized data from the Womens Health Initiative (WHI) cohort to assess whether 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) are associated with a decreased risk of melanoma. METHODS The study population consisted of 119,726 postmenopausal white women, in which 1,099 cases of malignant melanoma were identified over an average of 10.9 (S.D. 2.8) years of follow-up. All cases were confirmed by review of medical records and pathology reports. Information on statin use and duration was collected at baseline, and at select years during follow-up. Self- and interview-administered questionnaires were used to collect information on other risk factors. Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Analyses investigated the association of any statin use, type, potency, category and duration of use with melanoma. RESULTS Statins were used by 8,824 (7.4%) women. The annualized rate of melanoma was 0.09% among statin users and 0.08% among nonusers. The multivariable adjusted HR for statin users compared with nonusers was 1.09 (95% CI==0.86-1.40). There were no significant differences in risk based on type of statin, potency, category, or duration of use. There was no effect by tumor stage. CONCLUSIONS There was no significant association of melanoma with use of statins among postmenopausal women in the WHI cohort.

Abstract A59: Prospective analysis of the association between use of statins or other lipid-lowering agents and colorectal cancer risk

Background: Experimental and epidemiologic data suggest that 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) have antitumor activity against colorectal cancer (CRC). We utilized data from the population-based Women9s Health Initiative (WHI) cohort to assess whether statins are associated with a decreased risk of CRC. Methods: The study population included 159,219 postmenopausal women ages 50-79 at baseline, in which 2,000 cases of CRC were identified over an average of 10.7 (2.9) years of follow-up. All cases of CRC were confirmed by review of medical records and pathology reports. Participants were asked to bring all current medications to their screening interviews and clinic staff entered information on statin use and other lipid lowering medications into the WHI database. Self- and interviewer-administered questionnaires were used to collect information on other CRC risk factors. Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Analyses investigated the association of any statin use, type of statin, statin potency, and duration of use with CRC. Statistical tests were two-sided. Results: Statins were used by 12,030 (7.6%) women in the cohort. The annualized rate of CRC was 0.13% among statin users and 0.12% among nonusers. The multivariable adjusted HR for statin users compared with nonusers was 0.99 (95% CI=0.83 to 1.20, p=0.95). There was no trend in risk of CRC by duration of statin use, with HR = 0.91 (95% CI=0.66 to 1.27) for 3 years of use. There was no relationship between type of statin use, statin potency (low, medium and high), or use of other lipid-lowering medications and CRC risk. In addition there was no relationship between statin use and tumor location (proximal, distal and rectal), or clinical features (tumor stage, grade or histology). Conclusions: Statin use was not associated with a decrease in CRC risk in the WHI cohort. Citation Information: Cancer Prev Res 2010;3(12 Suppl):A59.