Roy West

Interaction between alcohol drinking and obesity in relation to colorectal cancer risk: a case-control study in Newfoundland and Labrador, Canada

BackgroundWhile substantive epidemiological literature suggests that alcohol drinking and obesity are potential risk factors of colorectal cancer (CRC), the possible interaction between the two has not been adequately explored. We used a case-control study to examine if alcohol drinking is associated with an increased risk of CRC and if such risk differs in people with and without obesity.MethodsNewly diagnosed CRC cases were identified between 1999 and 2003 in Newfoundland and Labrador (NL). Cases were frequency-matched by age and sex with controls selected using random digit dialing. Cases (702) and controls (717) completed self-administered questionnaires assessing health and lifestyle variables. Estimates of alcohol intake included types of beverage, years of drinking, and average number of alcohol drinks per day. Odds ratios were estimated to investigate the associations of alcohol independently and when stratified by obesity status on the risk of CRC.ResultsAmong obese participants (BMI ≥ 30), alcohol was associated with higher risk of CRC (OR: 2.2; 95% CI: 1.2-4.0) relative to the non-alcohol category. Among obese individuals, 3 or more different types of drinks were associated with a 3.4-fold higher risk of CRC relative to non-drinkers. The risk of CRC also increased with drinking years and drinks daily among obese participants. However, no increased risk was observed in people without obesity.ConclusionThe effect of alcohol of drinking on CRC seems to be modified by obesity.

Measles, Mumps and Rubella Vaccine

The current state of knowledge regarding the safety of measles, mumps and rubella vaccine (MMR) is reviewed. Although there are known adverse reactions to the vaccine, the majority are relatively minor and have no long term consequences, and those that do have long term consequences are extremely rare. Contraindications, known adverse reactions that may follow MMR immunisation, publicised adverse events for which a causal association with MMR has not been established, and the complications that may follow an infection with wild-type measles, mumps or rubella, are discussed. The article also discusses, with examples, the misleading information that can be obtained on the internet and in the public press.It is vital that the general public have an understanding of the great benefits and low risks associated with the use of MMR vaccine, because it is important that they consent to the administration of MMR vaccine to their children in order to ensure the success of universal immunisation programmes and the control of measles, mumps and rubella. Therefore, it becomes increasingly important for health professionals to use innovative education methods to promote immunisation and counteract the incorrect and misleading information that is readily available on the internet and in the media.

Responses by breast and prostate cancer patients to out-of-pocket costs in Newfoundland and Labrador

PURPOSE Cancer patients face substantial care-related out-of-pocket (oop) costs that may influence treatment decisions, attitudes, and use of drug- or appointment-related cost-saving strategies. We examined the relationship between oop costs and care-related responses by patients. METHODS We surveyed 170 prostate and 131 breast cancer patients presenting at clinics or support groups, or listed on the cancer registry in Newfoundland and Labrador. RESULTS In the 3-month period before the survey, 18.8% of prostate and 25.2% of breast cancer patients had oop costs greater than

Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket costs for cancer care.

500. Those oop costs consumed more than 7.5% of quarterly household income for 15.9% of prostate and 19.1% of breast cancer patients. Few patients (8.8% prostate, 15.3% breast) ever adopted any drug- or appointment-related cost-saving strategy. Few patients (7.2% prostate, 9.6% breast) said oop costs influenced treatment decisions, told their physicians about their oop costs (27.0% prostate, 21.1% breast), or were aware of available financial assistance programs (27.3% prostate, 36.9% breast). Compared with patients having low or moderate oop costs (22.9% prostate, 16.7% breast, and 25.7% prostate, 58.3% breast respectively), a larger proportion of prostate (56.0%) and breast (58.3%) cancer patients with high oop costs said that those costs created stress. Among prostate cancer patients, a larger proportion of those having high oop costs (compared with low or moderate costs) used drug-related (22.2% vs. 3.3% and 9.6% respectively) and appointment-related (11.1% vs. 1.1% and 3.8% respectively) cost-saving strategies, said oop costs created an unusual amount of stress (48.0% vs. 18.4% and 10.4%), and had difficulty paying those costs (29.2% vs. 6.2% and 10.4%). CONCLUSIONS For a small group of breast and prostate cancer patients, oop costs are high, but rarely lead to the use of care-related cost-saving strategies or influence care decisions.