Madeleine J. Goodman

Factors associated with mammographic pattern

Wolfes criteria were assigned to mammograms of 202 women without breast cancer. Parity decreased the frequency of P2 patterns but not DY. P1 and N1 patterns apparently increased at the expense of P2 patterns. For every birth, the probability that a P2 pattern changed to P1 or N1 was roughly 7 or 8%. This effect was not limited to the first pregnancy, but also held for additional pregnancies. Low body weight was associated with dysplasia and prominent duct patterns. Reported declines of radiographic density with increasing age and/or menopause were confirmed. Ethnic group was unrelated to parenchymal pattern.

The compatibility of hunting and mothering among the agta hunter-gatherers of the Philippines

Womens hunting is widely held biologically impracticable in foraging societies, chiefly because hunting is presumed incompatible with maternal responsibilities. A three-year study of hunting practices among the Agta Negrito people of northern Luzon reveals womens active participation in hunting, singly and in groups, without detriment to normal fertility and child care.

Menarche, pregnancy, birth spacing and menopause among the Agta women foragers of Cagayan Province, Luzon, the Philippines

The reproductive histories of 74 post-menarcheal Agta Negrito women, tropical foragers of Cagayan province, north-eastern Luzon, the Philippines are described and analysed in comparison with data collected by Howell on Dobe !Kung hunter-gatherers. Among the Agta, mean age at menarche is 17, mean age at first live birth is 20.14 years, mean completed parity is 6.53 and mean age at menopause is 44. Average height is 141.24 cm and average weight 36.72 kg. No time trends were detected in age at menarche and age at first live birth among the Agta. Average spacing between live births where an infant survives until the birth of the next sibling was 2.85 years. Compared to the Dobe !Kung, Agta women have later menarche, but shorter birth spacing and a longer active childbearing span.

Factors associated with breast structure in breast cancer patients

The breast duct patterns and radiographic density, or dysplasia, of 104 breast cancer patients in Hawaii were examined by mammography. The proportions of the four types of breast structure were analyzed for possible relation with age, menopausal state, height, weight, and race. Multiple regression analysis indicated that menopausal state appears to be more important than age per se for the general change in breast structure. Low body weight, but not race, is associated with prominent duct patterns and dysplasia.

The Overselling of Genetic Anxiety

B rochures warning American Jews against genetic diseases are printed in blue on white, the colors of the Jewish prayer shawl and of the flag of Israel. One logo shows the profile of a childs face inset into a Star of David from which falls a single tear. The design symbolizes in particular the tragedy of Tay-Sachs disease (TSD) (See box on p. 21). Normal in appearance at birth, Tay-Sachs children begin to regress and lose contact with their families and environment within the first year of life, declining inexorably toward a totally vegetative state. Death is inevitable, but the child may survive helplessly for as long as two to three years, or even to age four. Frustrated by the lack of any known cure, physicians, geneticists, families, and charitable groups have focused their efforts on preventive measures to combat TSD. Since the early 1970s the effort has largely been concentrated on mass screening among the Jewish population to detect carriers of the disease and to offer them genetic counseling. Unlike the mass screening for sickle cell trait, initiated in the same period, which was severely criticized and eventually stopped on the grounds that it stigmatized the black population and offered no therapeutic benefits to carriers, Tay-Sachs screening has generally been considered a model of community-professional cooperation. Yet we believe that this mass screening effort also involves serious ethical problems-in the style and content of its educational program, in its use of community resources and leadership, and

Breast cancer in multi-ethnic populations: The Hawaii perspective

SummaryThe five major ethnic groups in Hawaiis population of 1.1 million are the Japanese, comprising 23%; Caucasians, 23%; ethnic Hawaiians, 19.9%; Filipinos, 11.3%; and Chinese, 4.8%. Only 14% of the population is foreign born. Breast cancer incidences are 29.2 per 100,000 among Filipinos, 51.3 for Japanese, 64.1 for Chinese, 104.3 for Hawaiian, and 105.6 for Caucasian women. The Caucasian incidence is similar to mainland US rates, but the incidence among Hawaiis Japanese is more than twice the rate in Japan. Japanese in Hawaii have less postmenopausal breast cancer than Caucasians, fewer axillary lymph node metastases, and a greater proportion of non-invasive tumors. Late stage at diagnosis is common among Filipino and ethnic Hawaiian women, and their risk of death is 1.5–1.7 times that of Caucasian, Chinese, and Japanese women with the disease, even after adjustment for age, extent of disease, and socio-economic status. In the BCDDP screening study, only 20% of breast cancers detected in ethnic Hawaiians were not yet palpable and were found by mammography alone. Comparative studies of diet and estrogen levels in the ethnic groups of Hawaii and the parental populations in Japan and the West do not account for the degree of variation observed in breast cancer incidence and tumor pathology. Future research directions are suggested with a view to accounting for these differences.

Prevention--how misuse of a concept undercuts its worth.

Some health leaders and researchers have launched mass prevention programs without sound biomedical groundwork. They have oversold the benefits of prevention and underestimated the secondary effects. Some have forced nonmedical concerns into the medical model. Others have blurred the distinctions between prevention and other measures such as screening or therapy. Some have transferred responsibility for disease to the victim. A few have imputed magical powers to certain symbols of prevention, in order to create an illusion of control.

Diabetes mellitus: discrimination between single locus and muItifactorial models of inheritance

Family data from 6,559 diabetic propositi were analyzed using the method of complex segregation analysis in an attempt to discriminate the two models of two‐allele single‐locus inheritance and multifactorial inheritance for early, middle, and late onset diabetes. The three parameters in the single locus model were: degree of dominance, penetrance, and proportion of phenocopies.

Wolfe's mammographic classification and breast cancer risk: the effect of misclassification on apparent risk ratios

The effect of misclassification of Wolfes mammographic classifications was investigated using data from two radiologists. If there are only two risk groups (high and low), the apparent relative risk expected from typical surveys would be around 2 or 3, even if the true relative risk is very high. If each of Wolfes four classes has its own risk, the difference between N1 and P1, on the one hand, and P2 and DY on the other, would be almost lost due to misclassification. Published surveys in which the observed relative risks for the high-risk group (P2 and DY) are low are not inconsistent with Wolfes original finding of a high relative risk: misclassification can greatly distort estimates of relative risks. If misclassification can be managed by restricting uncertain mammograms to one class (or by removing them from the study altogether), the bias can be greatly reduced.

The distribution of estradiol in the sera of normal Caucasian, Chinese, Filipina, Hawaiian and Japanese women living in Hawaii.

Mean concentrations of sex-hormone-binding-globulin (SHBG) and the percentage distribution of estradiol between the non-protein-bound, albumin-bound and SHBG-bound fractions were not different in Caucasian, Hawaiian, Chinese, Japanese and Filipinas living in Hawaii. The widely varying incidence rates for breast cancer are therefore not explained by variations in the availability of estradiol.