Ralph J. Coates

Progress in cancer screening practices in the United States: Results from the 2000 National Health Interview Survey

Understanding differences in cancer screening among population groups in 2000 and successes or failures in reducing disparities over time among groups is important for planning a public health strategy to reduce or eliminate health disparities, a major goal of Healthy People 2010 national cancer screening objectives. In 2000, the new cancer control module added to the National Health Interview Survey (NHIS) collected more detailed information on cancer screening compared with previous surveys.

The association between fruit and vegetable intake and chronic disease risk factors.

Understanding the associations between fruit and vegetable intake and other health behaviors is important for properly interpreting the rapidly growing number of studies that link low intakes of fruits and vegetables to the risk of cancer and cardiovascular disease. To examine the association between fruit and vegetable intake and behavioral risk factors for chronic diseases, we analyzed data from a population-based behavioral risk factor survey. Data were collected in 1990 from 21,892 adults in 16 states by a random-digit-dial telephone survey. Respondents answered questions about behaviors related to chronic disease risk, including their frequency of intake of fruits and vegetables, using a six-item questionnaire. Consumption of fruits and vegetables was lowest among those who also reported that they were sedentary, heavy smokers, heavy drinkers, or had never had their blood cholesterol checked. Because fruit and vegetable intake covaries with several other chronic disease risk factors, it is important to account for possible confounding between fruit and vegetable intake and other behaviors in etiologic studies of the risk of cancer and cardiovascular disease.

Evaluation of a brief telephone questionnaire to estimate fruit and vegetable consumption in diverse study populations

We evaluated use of a six-item telephone questionnaire to estimate fruit and vegetable intakes in five diverse populations. Researchers administered the telephone questionnaire to persons who had previously undergone more extensive dietary assessment. The study populations included 553 middle-aged and older adults in Beaver Dam, WI; 252 middle-aged and older women throughout Wisconsin; 150 parents of school children in Augusta, GA; 73 low-income, Hispanic mothers in Chicago, IL; and 51 older adults in Arizona. Spearman correlation coefficients between total fruit and vegetable intakes measured by the brief telephone survey and by more extensive food frequency questionnaires were 0.47 (Augusta), 0.48 (Arizona), 0.56 (Wisconsin), and 0.57 (Beaver Dam). Correlation between intakes measured by the brief telephone survey and by multiple diet records or recalls were 0.29 (Arizona), 0.46 (Chicago), and 0.54 (Beaver Dam). With the exception of Arizona, mean daily fruit and vegetable intakes measured by the telephone survey were similar to intakes estimated by multiple diet records or recalls and lower than those estimated by extensive food frequency questionnaires. Although caution may be needed in interpreting dietary reports from some ethnic subgroups, this brief telephone questionnaire may be useful for surveillance of fruit and vegetable intake in the United States. (Epidemiology 1993;4:455–463)

Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening a systematic review

Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet not all people who should be screened are screened, either regularly or, in some cases, ever. This report presents the results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of interventions designed to increase screening for breast, cervical, and colorectal cancers by increasing community demand for these services. Evidence from these reviews indicates that screening for breast cancer (mammography) and cervical cancer (Pap test) has been effectively increased by use of client reminders, small media, and one-on-one education. Screening for colorectal cancer by fecal occult blood test has been increased effectively by use of client reminders and small media. Additional research is needed to determine whether client incentives, group education, and mass media are effective in increasing use of any of the three screening tests; whether one-on-one education increases screening for colorectal cancer; and whether any demand-enhancing interventions are effective in increasing the use of other colorectal cancer screening procedures (i.e., flexible sigmoidoscopy, colonoscopy, double contrast barium enema). Specific areas for further research are also suggested in this report.

Prevalence and Predictors of BRCA1 and BRCA2 Mutations in a Population-Based Study of Breast Cancer in White and Black American Women Ages 35 to 64 Years

Although well studied in families at high-risk, the roles of mutations in the BRCA1 and BRCA2 genes are poorly understood in breast cancers in the general population, particularly in Black women and in age groups outside of the very young. We examined the prevalence and predictors of BRCA1 and BRCA2 mutations in 1,628 women with breast cancer and 674 women without breast cancer who participated in a multicenter population-based case-control study of Black and White women, 35 to 64 years of age. Among cases, 2.4% and 2.3% carried deleterious mutations in BRCA1 and BRCA2, respectively. BRCA1 mutations were significantly more common in White (2.9%) versus Black (1.4%) cases and in Jewish (10.2%) versus non-Jewish (2.0%) cases; BRCA2 mutations were slightly more frequent in Black (2.6%) versus White (2.1%) cases. Numerous familial and demographic factors were significantly associated with BRCA1 and, to a lesser extent, BRCA2 carrier status, when examined individually. In models considering all predictors together, early onset ages in cases and in relatives, family history of ovarian cancer, and Jewish ancestry remained strongly and significantly predictive of BRCA1 carrier status, whereas BRCA2 predictors were fewer and more modest in magnitude. Both the combinations of predictors and effect sizes varied across racial/ethnic and age groups. These results provide first-time prevalence estimates for BRCA1/BRCA2 in breast cancer cases among understudied racial and age groups and show key predictors of mutation carrier status for both White and Black women and women of a wide age spectrum with breast cancer in the general population.

Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma†‡

Few studies have addressed the issue of whether delays in the interval between medical consultation and the diagnosis and treatment of breast carcinoma are greater for African American women than for white women. The authors examined differences with respect to these delays and analyzed the factors that may have contributed to such differences among women ages 20–54 years who had invasive breast carcinoma diagnosed between 1990 and 1992 and who lived in Atlanta, Georgia.

The Scientific Foundation for Personal Genomics: Recommendations from a National Institutes of Health–Centers for Disease Control and Prevention Multidisciplinary Workshop

The increasing availability of personal genomic tests has led to discussions about the validity and utility of such tests and the balance of benefits and harms. A multidisciplinary workshop was convened by the National Institutes of Health and the Centers for Disease Control and Prevention to review the scientific foundation for using personal genomics in risk assessment and disease prevention and to develop recommendations for targeted research. The clinical validity and utility of personal genomics is a moving target with rapidly developing discoveries but little translation research to close the gap between discoveries and health impact. Workshop participants made recommendations in five domains: (1) developing and applying scientific standards for assessing personal genomic tests; (2) developing and applying a multidisciplinary research agenda, including observational studies and clinical trials to fill knowledge gaps in clinical validity and utility; (3) enhancing credible knowledge synthesis and information dissemination to clinicians and consumers; (4) linking scientific findings to evidence-based recommendations for use of personal genomics; and (5) assessing how the concept of personal utility can affect health benefits, costs, and risks by developing appropriate metrics for evaluation. To fulfill the promise of personal genomics, a rigorous multidisciplinary research agenda is needed.

Validation of the American Cancer Society Cancer Prevention Study II Nutrition Survey Cohort Food Frequency Questionnaire.

We assessed the validity and reproducibility of a self-administered 68-item food frequency questionnaire completed in 1992-1993 by approximately 185,000 adults. Four hundred forty-one participants completed four 24-hour dietary recall interviews over a 1-year period and a repeat administration of the food frequency questionnaire. For 20 nutrients and 10 food groups, measured nutrient intakes, but not food group intakes, were consistently lower by food frequency questionnaire than by recall. Energy-adjusted, attenuation-corrected Pearson validity correlations ranged from 0.12 to 0.80, with a median of 0.58. Reproducibility measures were generally high, with a median of 0.69. The food frequency questionnaire performed similarly to food frequency questionnaires used in other cohort studies, indicating similar ability to examine diet-disease relations.

Relation of regimens of combined hormone replacement therapy to lobular, ductal, and other histologic types of breast carcinoma†

The incidence of invasive lobular carcinoma has been increasing among postmenopausal women in some parts of the United States. Part of this may be due to changes in classification over time. However, the use of combined (estrogen and progestin) hormone replacement therapy (CHRT) also has increased during the last decade and may account in part for the increase in invasive lobular breast carcinoma.

Intake of food groups and associated micronutrients in relation to risk of early-stage breast cancer†

Epidemiologic studies have evaluated the risk of breast cancer related to dietary fat intake, but only recently have other dietary factors received attention. Frequent intakes of fruit, vegetables and fiber have been associated with low risk of the disease in some studies but results are inconsistent. In a large case‐control study of early‐onset breast cancer, we evaluated risk related to a variety of food groups, associated micronutrients and non‐nutritive constituents. Cases treated with chemotherapy appeared to have altered reporting of food intake and were excluded. Analyses were restricted to 568 cases with in situ and localized disease and 1,451 population‐based controls. Reduced risks were observed for high intake of cereals and grains [odds ratio (OR) = 0.84, 95% confidence interval (CI) = 0.6–1.1 for highest compared with lowest quartile], vegetables (OR = 0.86, 95% CI = 0.6–1.1), beans (OR = 0.87, 95% CI = 0.7–1.2) and fiber from beans (OR = 0.88, 95% CI = 0.7–1.2). However, no trends of decreasing risk across quartiles of increasing intake were observed. Risk was not associated with dietary constituents related to these food groups including dietary fiber, carotenoids, vitamins A, C and E and folate. Incorporation of information from vitamin supplements did not alter the results for micronutrients. Our data suggest that intakes of cereals and grains, vegetables and beans are associated with minimal, if any, reduction in risk of early‐stage breast cancer among young women. Int. J. Cancer 82:315–321, 1999. Published 1999 Wiley‐Liss, Inc.