J. Wister Meigs

Early menopause in long-term survivors of cancer during adolescence

Objective: We attempted to investigate the risk of early menopause after treatment for cancer during childhood or adolescence. Study Design: We interviewed 1067 women in whom cancer was diagnosed before age 20, who were at least 5-year survivors, and who were still menstruating at age 21. Self-reported menopause status in survivors was compared with that in 1599 control women. Results: Cancer survivors, with disease diagnosed between ages 13 and 19, had a risk of menopause four times greater than that of controls during the ages 21 to 25; the risk relative to controls declined thereafter. Significantly increased relative risks of menopause during the early 20s occurred after treatment with either radiotherapy alone (relative risk 3.7) or alkylating agents alone (relative risk 9.2). During ages 21 to 25 the risk of menopause increased 27-fold for women treated with both radiation below the diaphragm and alkylating agent chemotherapy. By age 31, 42% of these women had reached menopause compared with 5% for controls. Conclusions: Treatment for cancer during adolescence carries a substantial risk for early menopause among women still menstruating at age 21. Increasing use of radiation and chemotherapy, together with the continued trend toward delayed childbearing, suggests that these women should be made aware of their smaller window of fertility so that they can plan their families accordingly.

Serum lipids, hypertension and coronary artery disease☆☆☆

Abstract The serum lipids were measured in 115 patients who had suffered a myocardial infarction at least ten days previously and in 397 apparently healthy men of various ages. All persons studied were in the postabsorptive state. A smaller number of normal women and women who had suffered a coronary attack was also investigated. A few persons with diabetes were considered separately. Serum triglyceride concentrations were increased above 5.4 mEq./L. in 5 per cent of seventy-three normal men twenty to twenty-nine years of age, in 36 per cent of 325 normal men aged thirty and over, and in 82 per cent of all patients with coronary artery disease. High serum cholesterol concentrations or hypertension appeared to increase the risk of coronary disease in persons with high serum triglycerides, but by themselves seemed to carry little risk. An exception was the occurrence of high serum cholesterol without high serum triglycerides in a small number of patients with coronary artery disease under age fifty. At all ages, however, the vast majority of patients exhibited an increase in serum triglyceride concentration as the most characteristic abnormality.

Psychosocial consequences of childhood and adolescent cancer survival

A Connecticut Addendum to a multi-center National Cancer Institute study was developed to investigate psychosocial effects of long-term childhood and adolescent cancer survival. Cases (450), drawn from the files of the Connecticut Tumor Registry and 587 of their siblings were located and interviewed. Overall response rate was 84%. The frequency of lifetime major depression in survivors (males, 15%; females, 22%) did not appear to differ from that of their siblings (males, 12%; females, 24%) and was similar to those reported in the literature for the general population. The usual correlates of depression (sex, marital status, perception of health) were observed, independent of a history of a childhood malignancy. There were no differences in the reported frequencies of suicide attempts, running away or psychiatric hospitalizations for either sex. Eighty percent of the male survivors were rejected from the armed forces, 13% from college and 32% from employment. These values were significantly higher than those of the male siblings. Female survivors were significantly more likely than their sisters to be denied entrance into the military (p less than 0.05), but no differences were observed between females with respect to college or employment. Both sexes had more difficulty obtaining health and life insurance than their siblings (p less than 0.0001). Although survivors of childhood and adolescent cancer do not seem to be at excess risk for major depression, they do appear to have difficulty attaining certain major socioeconomic goals.

The relationship of environmental lead to blood-lead levels in children☆

An in-depth study of the distribution of lead sources in the residential environment of 377 children in New Haven, Connecticut, was carried out. Substantial amounts of lead were present in soil, paint, and house dust throughout New Haven, but not in air or water. Multiple regression modeling indicated that the most important contributors to variation in childrens blood-lead levels were soil lead and exterior house paint lead. Using the best five-variable model only 11.7% of the variation in the childrens blood-lead levels could be explained. This led to the conclusion that availability of lead in the residential environment did not account for most of the variation observed in the population.

Medical Absenteeism Among Cigarette, and Cigar and Pipe Smokers

A retrospective study was made of medical absenteeism among 226 male, hourly paid employees of a manufacturing company for the nine-year period 1956 through 1964. Subjects were aged 55 to 59 in 1965 and were examined and interviewed regarding smoking habits at that time. There were significant associations of high absenteeism with cigarette smoking and equally or more significant associations of low absenteeism with cigar or pipe smoking. Considerable overlapping of individual absentee rates among groups divided by smoking habits suggested caution in drawing causal conclusions about these associations. Results might fit the hypothesis that adoption of the habit of cigar or pipe smoking by middle age occurred among men with constitutional and absentee behavioral characteristics tending to distinguish them from men with a lifelong cigarette smoking habit.

Mathematical modeling of cancer incidence rates: linear models of colon cancer in Connecticut.

Abstract Mathematical models of cancer incidence were developed to evaluate substantively trends in age and period of diagnosis and to identify differences in these trends with regard to qualitative variables such as sex and anatomical localization of tumor. Parameter estimates were obtained through a weighted least-squares procedure, and hypothesis testing was carried out using minimum modified χ 2 statistics. These procedures were applied to colon cancer incidence rates for Connecticut males and females during the period 1940–1974. The initial model of changes in incidence over calendar time for males and females showed a different pattern and excess risk among males and a possible birth cohort effect among females. The changing pattern of risk in males was modeled as an exponential function of age and a two-stage, age-related process was identified. While proportional comparisons of time trends between the ascending and sigmoid colon showed significant differences for certain groups, patterns in absolute changes were not found to be statistically different. Using mathematical models of cancer incidence rates for substantive analysis can be useful for hypothesis generation in cancer epidemiology. Such modeling proves worthwhile because it allows the investigator to summarize the trends and patterns of cancer incidence through model parameters which then may be tested statistically for the purpose of identifying significant effects of independent variables.