Edward D. Lustbader

Ethnic differences in risk perception among women at increased risk for breast cancer

SummaryThere has been increasing interest in the role of cultural and ethnic factors in breast cancer risk perceptions and screening practices. This study examined ethnic differences in breast cancer risk perception in 112 African American and 224 white women ages 35 and older who had at least one first-degree relative diagnosed with breast cancer. These samples were matched for education and age. Data on breast cancer risk factors, risk perceptions, breast cancer worries, and breast cancer screening practices were collected through structured telephone interviews. The results show that African American women were significantly less likely than white women to report heightened perceptions of personal risk after their relative was diagnosed with breast cancer (61% vs 82%; p<.001). Despite this, African American women had significantly greater concerns about their personal risk of breast cancer and worries about their affected relative. African American women also scored significantly higher than white women on a measure of avoidance of breast cancer-related thoughts and feelings. These psychological variables were associated independently with breast cancer risk perception in multivariate models, taking precedence over demographic and risk factor predictors. Observed ethnic differences in breast cancer risk perceptions and psychological distress may be attributable to the influence of cultural factors particular to people of African descent, such as the importance of interpersonal relationships, spirituality, and time orientation. An Africentric perspective is used to interpret these findings and to provide suggestions for delivering effective breast cancer risk counseling to African American women.

HOST RESPONSES TO HEPATITIS-B INFECTION IN PATIENTS WITH PRIMARY HEPATIC CARCINOMA AND THEIR FAMILIES: A Case/Control Study in Senegal, West Africa

A case/control study of patients with primary hepatic carcinoma (P.H.C.) and their families was carried out in Dakar, Senegal. 28 P.H.C. cases were matched by age,sex, and ethnic group with 28 controls. Serum was collected from cases, controls, parents (28 mothers, 27 fathers) of cases, parents of controls, 71 siblings of cases, and 58 siblings of controls. Assays of their sera for hepatitis-B surface antigen (HBsAg), antibody to HBsAg (anti-HBs) and antibody to hepatitis-B core antigen (anti-HBc) produced the following results. (1) Nearly all P.H.C. cases (97%) and controls (93%) had some evidence of infection with hepatitis-B virus (H.B.V.), but the cases were more likely to be anti-HBc(+) and less likely to be anti-HBs(+) than the controls. (2) Most of the mothers of the cases were HBsAg(+) (71%), whereas only 14% of the mothers of controls were HBsAg(+). Lover titres of anti-HBs were less common in the mothers of the cases. (3) None of 27 fathers of cases had detectable anti-HBs, but 13 (48%) of the fathers of controls were anti-HBs(+). (4) Siblings of the P.H.C. cases were more likely to have anti-HBs than either their sibs with P.H.C. or the sibs of the controls. However, sibs of P.H.C. cases had lower titres of anti-HBs than the sibs of the controls. These data are consistent with the hypothesis that the P.H.C. cases were infected with H.B.V. by their mothers and that there was an environmental factor which affected the immunological response of all family members to H.B.V. Infection with H.B.V. and the mode of response to that infection among members of families appear to be major factors in the aetiology of P.H.C. in West Africa.

Survival in Childhood Acute Lymphocytic Leukemia: Effect of Protocol and Place of Treatment

The objective of this study was to determine the effect of place and type of initial treatment on survival from acute lymphocytic leukemia (ALL). Every one of the 327 children under 15 years of age diagnosed with ALL from 1970 to 1975 in a 31-county area designated the Greater Delaware Valley, were studied. Treatment according to protocol was associated with improved survival, yielding a 4 year survival of 60% vs 19% for nonprotocol treated patients (p less than 0.001). There was also a significantly improved survival rate among patients treated in a cancer center, especially for those with a low white blood count (WBC) at diagnosis. The prognostic importance of WBC, age, and sex was confirmed.

Other Cancers in Uveal Melanoma Patients and Their Families

To determine associations with other cancers, 400 consecutive uveal melanoma patients examined at Wills Eye Hospital between 1984 and 1985 were surveyed regarding personal and family history of cancer. Responses were received from 333 (83%). Sixty patients reported 43 nonbasal cell second primary cancers, which were confirmed pathologically or by physician records. The overall prevalence of nonbasal cell cancers diagnosed in uveal melanoma patients by December 1985 was over two times greater than the expected prevalence, based on the Connecticut Tumor Registry data for an age- and sex-matched population. Gynecologic cancers tended to be more common in uveal melanoma female patients than in the comparison population. Although the observed prevalence of cutaneous melanoma was not significantly greater than expected, three cases with both primary cutaneous and uveal melanoma were reported. Family histories of cutaneous melanoma were confirmed in 14 patients, and uveal melanoma in two patients. Data suggested that the overall cancer prevalence in uveal melanoma patients may be increased, that hormonal factors may play a role in the genesis of this malignancy, and that there may be a link between cutaneous and uveal melanoma.

Dietary practices of early life and spontaneous tumors of the Rat

A complete life history was obtained of the dietary practices, growth responses, and diseases of outbred male Charles River COBS rats permitted to select their own diets. Simple correlation analyses proved inadequate for detecting an association between any single factor at any age and tumor development. A multifactorial model showed that animals that developed tumors could be distinguished from those that did not, solely on the basis of age- or weight-specific information prior to maturity. The combination of variables that maximize the probability of a neoplasm is: 1. a high absolute protein intake shortly after weaning, 2. a high degree of efficiency in converting consumed food into body mass at the time the individual enters puberty, 3. a high level of protein intake relative to body weight during the early adult period and concomitantly, 4. a high level of food intake, and 5. a rapid growth rate during early postnatal life so that comparatively less time is required to attain a specified body weight than a subsequent weight increment. The opposite set of conditions reduces the probability of neoplasm occurrence, which is even further minimized if the proportion of protein in the diet in early postweaning life and the absolute intake of protein during the early adult period are relatively high. Differences in temporal-specific dietary practices and growth responses accounted for differences in the tissue origin of the tumors.

Elevated Serum Iron Levels and Persistent Australia Antigen (HBSAg)

Excerpt To the editor: Kolk-Vegter, Bosch, and van Leeuwen (1) described 11 patients with chronic renal disease treated at a hemodialysis unit in Amsterdam, The Netherlands. They developed anicteri...

A Diagnostic Statistic for the Score Test

Abstract This article provides exact and approximate expressions for the change in the score test on deletion of observations. Deletions of individuals and of entire risk sets from matched case-control and survival studies are discussed in detail. A simple formula is derived, which measures the contribution of individual strata to score tests based on combining several contingency tables. The diagnostic is illustrated by application to the Stanford heart-transplant data.

IRON AND IRON BINDING PROTEINS IN PERSISTENT GENERALISED LYMPHADENOPATHY AND AIDS

Hoofnagle et al suggested that this antibody may represent spontaneous maturation of antibody-producing clones of lymphocytes or exposure to unrelated environmental antigens with shared epitopes. Although subdeterminant specificity was not determined in the present case, the fact that it appeared to be IgM antibody and decreased with the appearance of HBsAg, suggests that it may be similar to the antibody described by Hoofnagle et al. The implication of this case report is that anti-HBc, not anti-HBs, should be used to determine the susceptibility or immunity of an individual to HBV and to decide whether HBV vaccine should be used. In our own medical centre, we screen high risk employees for anti-HBc. Those who are positive are tested for anti-HBs, and if the anti-HBs is negative, their sera are tested for HBsAg. This identifies those who are immune or susceptible, and those who are chronic carriers.

Tests of the null hypothesis in case-control studies

The relative merits of the likelihood ratio statistic, the Wald statistic, and the score statistic are examined by an empirical evaluation based on matched case-control data. A mixture model for the relative-odds function is used. The likelihood ratio statistic is relatively constant for reasonable values of the mixture parameter, but the Wald statistic is unstable. The score statistic is shown to be independent of the mixture parameter. An exact expression is derived for the change in the score statistic upon deletion of risk sets, and an approximation is numerically evaluated.

Some problems of inference in cohort studies

This paper uses a detailed example to illustrate how to detect individual observations that disproportionately influence the results of hypothesis testing with relative risk regression models.