Flora Lubin

Parity, Oral Contraceptives, and the Risk of Ovarian Cancer among Carriers and Noncarriers of a BRCA1 or BRCA2 Mutation

BACKGROUNDnMultiparity and the use of oral contraceptives reduce the risk of ovarian cancer, but their effects on this risk in women with a BRCA1 or BRCA2 mutation are unclear.nnnMETHODSnWe conducted a population-based case-control study of ovarian cancer among Jewish women in Israel. Women were tested for the two founder mutations in BRCA1 and the one founder mutation in BRCA2 that are known to be common among Jews. We estimated the effects of parity and oral-contraceptive use on the risk of ovarian cancer in carriers and noncarriers in separate analyses that included all control women, who did not have ovarian cancer.nnnRESULTSnOf 751 controls who underwent mutation analysis, 13 (1.7 percent) had a BRCA1 or BRCA2 mutation, whereas 244 of 840 women with ovarian cancer (29.0 percent) had a BRCA1 or BRCA2 mutation. Overall, each additional birth and each additional year of use of oral contraceptives were found to lower the risk of ovarian cancer, as expected. Additional births were protective in separate analyses of carriers and noncarriers, but oral-contraceptive use appeared to reduce the risk only in noncarriers; among carriers, the reduction in the odds of ovarian cancer was 12 percent per birth (95 percent confidence interval, 2.3 to 21 percent) and 0.2 percent per year of oral-contraceptive use (-4.9 to 5.0 percent).nnnCONCLUSIONSnThe risk of ovarian cancer among carriers of a BRCA1 or BRCA2 mutation decreases with each birth but not with increased duration of use of oral contraceptives. These data suggest that it is premature to use oral contraceptives for the chemoprevention of ovarian cancer in carriers of such mutations.

Population attributes affecting the prevalence of BRCA mutation carriers in epithelial ovarian cancer cases in israel

OBJECTIVEnThe objective was to evaluate the prevalence of BRCA1/2 mutations in selected categories of ovarian cancer patients in Israel.nnnMETHODSnBlood samples and specimens of ovarian tumors were obtained in the course of a national case control study of women with ovarian cancer in Israel. Eight hundred ninety-six patients with epithelial ovarian cancer, 40 cases with nonepithelial ovarian cancer, and 68 with primary peritoneal cancer were tested for the BRCA mutations. Analysis of the three common BRCA mutations in Israel (185delAG, 5382insC in BRCA1, and 6174delT in BRCA2) was done using a multiplex polymerase chain reaction assay. A multivariate logistic regression model was used to assess the association of mutation carrier status and other factors (age, origin, family history, and clinical variables).nnnRESULTSnOf the 779 invasive epithelial ovarian cancer cases, 29.4% were mutation carriers. The prevalence of the mutations was higher among women below age 60 and in more advanced cases. The prevalence was low in mucinous tumors. There was almost a twofold excess of mutations among women with positive family history (45.7%), but still 26.5% of the family history negative cases were carriers. As expected, we found a higher rate of mutation carriers among the Ashkenazi group (34.2%) and 55% among Ashkenazi women with positive family history. No subjects born in North Africa were mutation positive.nnnCONCLUSIONnBRCA mutations are strongly associated with ovarian cancer and they are present in variable rates in distinct age, ethnic, and histopathologic categories.

Lifestyle Intervention in Obese Arab Women: A Randomized Controlled Trial

BACKGROUNDnFew randomized controlled trials on lifestyle interventions have been reported in non-Western populations; none have been reported in Arab populations.nnnMETHODSnFrom 2 Muslim Arab communities in Israel, obese, nondiabetic women aged 35 to 54 years with 1 or more components of the metabolic syndrome were randomized to either an intensive (n = 100) or a moderate (control) (n = 101) 12-month lifestyle intervention. Women in the intensive intervention had 11 individual and 11 group counseling sessions per year with a dietitian and 22 physical activity group sessions per year. Women in the moderate intervention had 3 individual and 2 group dietary counseling sessions per year and no guided physical activity. Cultural issues were addressed in the design and conduct of both interventions. The primary outcome measure was change in the metabolic syndrome and its components.nnnRESULTSnAt 12 months, the intensive intervention group had median declines of 3.0 mg/dL (to convert to millimoles per liter, multiply by 0.0555) in fasting plasma glucose and 4.5 mg/dL (to convert to millimoles per liter, multiply by 0.0113) in triglyceride levels compared with median increases of 1 mg/dL in fasting plasma glucose and 5.8 mg/dL in triglyceride levels in the moderate intervention group (P = .01 and P = .02, respectively). The median waist circumference decreased by 5.4 cm in the intensive intervention group and by 3.1 cm in the moderate intervention group (P = .10). The prevalence of the metabolic syndrome decreased by 4.0% in the intensive intervention group and increased by 5.2% in the moderate intervention group (P = .12).nnnCONCLUSIONnThe 12-month culturally sensitive intensive lifestyle intervention was effective in improving some of the metabolic syndrome components in obese Arab women. Trial Registration clinicaltrials.gov Identifier: NCT00273572.

An International Case Control Study of Adult Diet and Brain Tumor Risk: A Histology-Specific Analysis by Food Group

PURPOSEnExisting studies of diet and adult brain tumors have been limited by small numbers in histology-specific subgroups. Dietary data from an international collaborative case-control study on adult brain tumors were used to evaluate associations between histology-specific risk and consumption of specific food groups.nnnMETHODSnThe study included 1548 cases diagnosed between 1984 and 1991 and 2486 control subjects from 8 study centers in 6 countries. Of the 1548 cases, 1185 were gliomas, 332 were meningiomas, and 31 were other tumor types. Dietary consumption was measured as average grams per day.nnnRESULTSnWe found inverse associations between some vegetable groups and glioma risk, the strongest for yellow-orange vegetables (odds ratio [OR], 0.7, 95% confidence interval [CI], 0.5-0.9 for the 4th vs. 1st quartile of consumption, p for trend<0.001), and the association was limited to specific glioma subtypes. There was no association with cured meat. Non-cured meat was associated with a modest increase in glioma risk (OR, 1.3; 95% CI, 1.0-1.7 for 4th quartile vs. 1st quartile, p for trend=0.01). We also found positive associations between egg, grain, and citrus fruit consumption and glioma but not meningioma risk.nnnCONCLUSIONSnOur study suggests that selected dietary food groups may be associated with adult gliomas and its subtypes but not meningiomas.

Jews and Arabs in the Same Region in Israel Exhibit Major Differences in Dietary Patterns

The Jewish majority and Arab minority populations in Israel exhibit disparities in nutrition-related chronic diseases, but comparative, population-based dietary studies are lacking. We evaluated ethnic differences in dietary patterns in a population-based, cross-sectional study of Arab and Jewish urban adults (n = 1104; age 25-74 y). Dietary intake was assessed with an interviewer-administered, quantified FFQ. We used principal-component analysis to identify 4 major dietary patterns: Ethnic, Healthy, Fish and Meat Dishes, and Middle Eastern Snacks and Fast Food. The Ethnic and Healthy patterns exhibited major ethnic differences. Participants in the top Ethnic intake tertile (97% Arab) had modified Mediterranean-style Arabic dietary habits, whereas those in the bottom Ethnic tertile (98% Jewish) had central/northern European-style dietary habits. The Arab participants with less strongly ethnicity-associated dietary habits were younger [OR for 10-y decrease = 1.42 (95% CI: 1.21-1.68)] and male [OR = 2.23 (95% CI: 1.53-3.25)]. Jews with less strongly ethnicity-associated dietary habits were less recent immigrants [OR = 8.97 (95% CI: 5.05-15.92)], older [OR for 10-y decrease = 0.80 (95% CI: 0.69-0.92)], had post-secondary education [OR = 2.04 (95% CI: 1.06-3.94)], and reported other healthy lifestyle behaviors. In relation to the Healthy pattern, Arabs were less likely than Jews to be in the top intake tertile, but the magnitude of the difference was less in diabetic participants. Participants reporting other healthy lifestyle behaviors were more likely to have a high intake of the Healthy pattern. Substantial differences were found between Arabs and Jews in dietary patterns and suggest a need for culturally congruent dietary interventions to address nutrition-related chronic disease disparities.

Beauty product-related exposures and childhood brain tumors in seven countries: results from the SEARCH International Brain Tumor Study.

SummaryData from 1218 cases of childhood brain tumors (CBT) diagnosed between 1976 and 1994 and 2223 matched controls from the general population were included in an analysis of maternal beauty product exposure and beauty-related employment in 9 centers in 7 countries. A 50% increased odds ratio (OR) [95% confidence interval (CI) = 1.0–2.1] for CBT was observed among children of mothers who were exposed via personal use of and/or possible ambient contact with beauty products during the 5u2009years preceding the index child’s birth compared with children of mothers never exposed to beauty products during this time period. Overall maternal personal use of hair-coloring agents in the month before or during the pregnancy of the index child’s birth was not associated with CBT (OR = 1.0, CI = 0.83–1.3) or with astroglial (OR = 1.1, CI = 0.85–1.4), PNET (OR = 1.0, CI = 0.71–1.5) and other glial subtypes (OR = 1.0, CI = 0.62–1.0). Similarly, no statistically increased ORs or discernable pattern of risk estimates were observed for period of use or for number of applications per year for maternal personal use of hair-coloring agents overall or by histologic type. Among children born on or after 1980, increased ORs for CBT were associated with maternal non-work-related exposure to any beauty products (OR = 2.6, CI = 1.2–5.9), hair-dyes (OR = 11, CI = 1.2–90), and hair sprays (OR = 3.4, CI = 1.0–11). No overall increased OR for CBT was observed among children of mothers employed in beauty-related jobs during the 5xa0years preceding the index child’s birth compared with those who reported no beauty-related employment. In general, other specific beauty product-related exposures were not associated with increased ORs for CBT. Data from our study provide little evidence of an increased risk for CBT with mothers’ exposures to beauty products.

Family cancer history and risk of brain tumors in children: results of the SEARCH international brain tumor study

ObjectiveTo examine whether childhood brain tumors (CBTs) are associated with a family history of brain tumors or other cancers in an international case–control study.MethodsCancers in children’s first- and second-degree relatives were ascertained by interview with parents of 620 children with astroglial tumors, 255 with primitive neuroectodermal tumors, 324 with other CBTs, and 2,218 controls from Australia, Canada, France, Israel, Italy, Spain, and the US. These were used with histories of neurofibromatosis or tuberous sclerosis to exclude in subanalyses children with Li-Fraumeni or other hereditary syndromes predisposing to brain tumors.ResultsA first- or second-degree relative of 4% of children with astroglial tumors, 6% with PNET, 5% with other CBTs, and 5% of controls had had a brain tumor. Any potential differences were statistically non-significant, including when focusing on relatives diagnosed in childhood. In the US, where anatomical sites of relatives’ other cancers were known, CBT occurrence was not associated with any other specific site. Results were not markedly altered by exclusion of children with hereditary syndromes.ConclusionConsistent with most prior studies using these methods, we observed no strong relationship between CBT occurrence and cancers in family members.

Life-style habits and homocysteine levels in an elderly population.

Background and aims: Increased plasma total homocysteine (Hcy) is a known cardiovascular disease (CVD) risk factor, related to several components of the established CVD risk profile. Observational studies support the role of modifying life-style related risk factors such as diet, physical activity and alcohol consumption in CVD prevention. Regular physical activity protects against coronary artery disease, possibly through its role in controlling risk factors such as hypertension, diabetes mellitus and obesity, but also independently. The aim of our study was to test the hypothesis that there is an association between physical activity, life-style habits and plasma Hcy levels in an elderly population. Methods: In this cross-sectional study, 423 males and females aged 69.0±6.7 years completed an interview and laboratory examinations. Our main outcome measure was plasma levels of Hcy. Results: Mean Hcy values were 10.5±5.5 μmol/L (11.4±6.1 for males and 9.3±4.5 for females; p<0.001). Smoking and BMI were not found to be associated with Hcy levels. Physically active subjects, as well as B vitamin supplement users, had significantly lower Hcy levels (p=0.002 and p=0.004, respectively). In a multiple linear regression model, the Hcy level was 10% higher amongst participants with a sedentary life-style, 17% higher amongst males, 1% higher for each one-year increment in age, and 10% higher amongst participants who used no B vitamin supplements. Conclusions: Any level of physical activity was found to be an independent life-style habit associated with a lower Hcy level in an elderly population. This study supports existing recommendations for elderly persons to maintain a physically active life-style.

Lipoprotein profile changes during intense training of Israeli military recruits

The effect of prolonged strenuous military training on serum lipoproteins was studied in 73 new recruits. Dietary intake, body weight, and average energy expenditure were recorded, and blood samples collected at three time periods before training began (time 0), and after 6 and 12 wk of intense physical activity (times I and II, respectively). There was a significant increase in high density lipoprotein (HDL) cholesterol and a decrease in low density lipoprotein (LDL) cholesterol accompanying an increase of duration and intensity of exercise. HDL increased from 40.5 +/- 7.7 mg.dl-1 at time 0 to 44.5 +/- 9.4 mg.dl-1 at time I and to 52.8 +/- 8.7 mg.dl-1 at time II, and each mean P-value for increases in HDL from time 0-I, I-II, and 0-II were P < 0.0001). For LDL cholesterol, the mean decreases were -1.1, -6.1, and -7.3 mg.dl-1, respectively (P = 0.003 from I-II, and 0.01 from 0-II). These changes did not correlate with weight loss, reduced energy, or fat intake. We conclude that intense physical activity is associated with beneficial changes in the lipoprotein profile in new military recruits during a training period extending over 12 wk.