Raymond Seltser

Diet and other risk factors for cancer of the pancreas

The findings of a case‐control study of cancer of the pancreas, which was conducted in the Baltimore metropolitan area, are reported. Two hundred one patients with pancreatic cancer were matched on age (±5 years), race, and sex to hospital and non‐hospital controls, the latter selected by random‐digit‐dialing (RDD). All subjects were interviewed regarding diet, beverage consumption, occupational and environmental exposures, and medical and surgical history. Significantly decreased risks were associated with consumption of raw fruits and vegetables and diet soda, and significantly increased risks were associated with consumption of white bread when cases were compared with hospital and RDD controls. A significantly reduced risk was associated with consumption of wine when cases were compared to RDD controls. Risk ratios for consumption of coffee were not significantly different from one, although there appeared to be a dose‐response relationship in women. A moderate but statistically nonsignificant increase in relative odds was found for cigarette smoking, and cessation of smoking was associated with a marked reduction in risk. No significant associations were found with particular occupational exposures. Tonsillectomy was associated with a significantly reduced risk, a finding that has been observed for other cancers as well. The current evidence indicates that pancreatic cancer is likely to result from a complex interaction of factors and suggests that the study of its etiology requires a multidisciplinary approach involving both laboratory and epidemiologic components.

Risk Factors in Stroke Due to Cerebral Infarction

In 1968 the Council on Cerebrovascular Disease of the American Heart Association authorized the appointment of a subcommittee to produce a statement concerning “risk factors for Stroke.” After working for over a year the Subcommittee reported that, because of inadequate data concerning “all or several of the factors,” they had been unable to produce a statement satisfactory to each Subcommittee member. Some were reluctant to set down a policy statement until every loophole was plugged—a task made extraordinarily difficult by the complexity of Stroke and the fact that prospective studies of large population groups are necessary for the acquisition of some needed data. Another problem was that of interpreting the phrase risk factors. Does this phrase imply that eliminating or minimizing a “risk factor” (for example, maintaining successful control of hypertension) automatically reduces the risk of Stroke for that individual? This therapeutic consideration may await an answer for years, although it must be admitted that the term “risk factors for Stroke” does suggest that careful treatment of one or several risk factors can help to prevent Stroke. In any event, the Subcommittee was admonished by its chairman, Dr. William Kannel, to consider the task a never-ending one; that data are now available indicating that certain phenomena are more commonly followed by Stroke and that these phenomena (culprits) should be publicly identified as elements or risk factors for Stroke. The Subcommittee decided to work first with the profile of the candidate at risk of a cerebral infarction—and so state. The Subcommittee realistically writes: “Any statement arrived at will be subject to periodic revision as more information is accumulated!” Obviously, new data may make changes necessary! Under Dr. Kannels talented and dedicated leadership the Subcommittee produced the statement which follows.

I. Epidemiology for stroke facilities planning

The Major factors known to be associated with stroke include increasing age, hypertension, cardiovascular disease and diabetes. However, many additional data are required to substantiate the role of other risk factors. The incidence, prevalence and mortality figures in this paper are presented in a form to be useful for palnning health facilities and manpower resources required in the proper management of stroke problems.