Lincoln Polissar

Menopausal estrogen use and the risk of breast cancer

SummaryThe relationship between the occurrence of female breast cancer and menopausal estrogen replacement was investigated in a population-based case-control study. One hundred and eighty-three white female residents of King County, Washington (ages 50–74) in whom breast cancer was diagnosed from July, 1977, through August, 1978, were interviewed with respect to reproductive and other factors, with emphasis on the use of estrogen-containing medication. For purposes of comparison, the same data were collected from 531 white female King County residents of the same ages without breast cancer. Use of menopausal estrogens was reported somewhat more commonly among controls than among cases (relative risk = 0.74, 95% confidence interval = 0.51−1.08) and some variation in proportions of users was present between different hysterectomy-oophorectomy subgroups. However, each of these differences could easily have been due to chance. No substantial trends in risk were apparent with increasing duration of use, time since first use, time since last use, or average dose. The findings suggest that in King County no important relationship exists between use of menopausal estrogens and the occurrence of breast cancer.

SURVIVAL OF COLORECTAL CANCER PATIENTS IN RELATION TO DURATION OF SYMPTOMS AND OTHER PROGNOSTIC FACTORS

The effect of duration of symptoms and other prognostic factors on survival was studied by interview using a population-based sample of 154 colorectal cancer patients. The authors found that symptom durations of up to approximately one year before diagnosis had no effect on survival. In addition, it was found that the total number of symptoms was a statistically significant predictor of survival, although no single symptom had a significant effect. Stage, sex, and site also were found to be significant predictors of survival, whereas age, socioeconomic status, and other factors were not predictive.

FACTORS AFFECTING PLACE OF DEATH IN WASHINGTON STATE, 1968-1981

A study was carried out to determine factors affecting place of death (home, hospital, nursing home or “other places”) among all 426,115 resident deaths in Washington State during 1968–1981, using death certificate information. Sixteen percent of deaths occurred at home, 74% in institutions (51% in hospitals, 23% in nursing homes) and 9% at “other places.” Age, marital status and cause of death all strongly affect place of death. Further, the effect of each factor was strongly dependent on the others. Sex had no effect on place of death after controlling for other factors. Elderly people died relatively more frequently in nursing homes, infants and middle aged people in hospitals and young adults in “other places.” The frequency of deaths at home was quite constant by age. Hospitals were the most common place of death following both vascular disease (including heart attack) and neoplasms, and nursing homes were the most common place of death following cerebrovascular disease (including “stroke”). Race, socioeconomic status and urban or rural residents affected the place of death only slightly or not at all. The place of death pattern changed little during the time period 1968–1981, except for a slight increase in frequency of home deaths and a corresponding decrease in the frequency of deaths in other places.Among cancer patients, the likelihood of death at home was positively associated with longer periods of survival after diagnosis. Cancer patients of hospitals serving targeted populations, such as veterans, were relatively more likely to die in a hospital and less likely to die in a nursing home compared to other cancer patients, suggesting that the “targeted” hospitals are sometimes serving a nursing home function. There was a marked difference in the terminal cancer caseload by hospital. The number of cancer deaths per cancer diagnosis varied widely across hospitals (0.1 to 1.6) and was unrelated to size of the hospital or level of services offered.Intervention aimed at affecting place of death, such as increasing the number of deaths at home, will need to take account of the joint effect of age, marital status and disease.

Care of patients with colorectal cancer. A comparison of a health maintenance organization and fee-for-service practices.

The presence of a population-based cancer registry in a community with a health maintenance organization (HMO) enabled a detailed, longitudinal comparison to be made of care given for colorectal cancer in an HMO with traditional fee-for-services (FFS) care. An interview survey of 39 HMO and 150 FFS patients was supplemented with data from the cancer registry. Patients seen by the two provider groups were similar with respect to sociodemographic characteristics, severity of disease at diagnosis, and concurrent medical conditions. The HMO patients received more prediagnostic care but did not receive definitive surgical treatment as quickly as the FFS group. There were few differences in care, however, once diagnosis was made; there were no differences in access to care, rates of definitive surgery, chemotherapy, radiation therapy, length of hospitalization, number of follow-up physician visits, and most measures of satisfaction with care. No differences in outcome, including 4-year survival and 1-year health status, were found. HMO patients expressed significantly less concern about the cost of their care. These findings suggest an initial hesitancy to provide definitive care by the HMO but no significant differences in either the process or outcome of care once definitive care is begun.

Non-Hodgkin's lymphoma among phenoxy herbicide-exposed farm workers in western Washington State

Abstract A case-control study conducted in western Washington State revealed a small but significant excess risk [1.33 (1.03-1.7)] of non-Hodgkins lymphoma (NHL) among farmers. Phenoxy herbicides did not independently increase NHL risks, but may enhance the risks associated with various pesticides and other chemicals commonly used in agricultural activities.