Search

A study to establish whether there is a relationship between smoking and mortality and an increased risk of ovarian and colorectal cancer is conducted. Results indicate that mortality due to smoking in women can be reduced if smoking is stopped and that there is a relationship between smoking and an increased risk of colorectal cancer but not ovarian cancer.

A large, national multicenter study is used to assess whether the genes CFH and LOC387715 are associated with age-related macular degeneration (AMD) and related visual loss. The results show that common polymorphisms in the genes CFH and LOC387715 are independently related to AMD progression after adjustment for other known AMD risk factors.

The relationship between extended work duration and rates of percutaneous injuries is assessed in a diverse population of interns in the United States. It is found that extended work duration and night work are associated with an increased risk of percutaneous injuries.

The associations of adult weight change since age 18 years and since menopause with the risk of breast cancer among postmenopausal women is assessed. The result suggests that weight gain during adult life, specifically since, menopause, increases the risk of breast cancer among postmenopausal women, whereas weight loss after menopause is associated with a decreased risk of breast cancer.

The effects of three healthful diets, each with reduced saturated fat intake, on blood pressure and serum lipids is compared. Results reveal that in the setting of a healthful diet, partial substitution of carbohydrate with either protein or monosaturated fat could further lower blood pressure, improve lipid levels, and reduce estimated cardiovascular risk.

Men who eat fish at least once a month can lower their risk of a stroke by 40%, according to a 12-year study of 43,671 men. Eating fish more frequently did not substantially lower the risk any more than 50%. Most strokes are caused by a blood clot in the brain that cuts off the blood supply to various parts of the brain. Fish consumption did not reduce the risk of a hemorrhagic stroke, which is caused by bleeding inside the brain.

Weight gain in adulthood may increase a woman's risk of developing breast cancer after menopause. This was one conclusion of a 16-year follow-up of 95,256 women participating in the Nurses' Health Study. During that time, 2,517 women developed breast cancer and 60% were postmenopausal. Weight gain during adulthood did not increase the risk of premenopausal breast cancer but increased the risk of postmenopausal breast cancer two-fold in women who did not use hormone therapy. Weight gain and hormone use combined were linked to one-third of postmenopausal breast cancer cases., Context.--Breast cancer is a major cause of mortality among women. It is important to identify modifiable risk factors for this disease. Objective.--To examine body mass index (BMI) at the age of 18 years and at midlife and adult weight change in relation to breast cancer incidence and mortality. Design.--Cohort study. Setting.--A cohort of 95 256 US female nurses aged 30 to 55 years who were followed up for 16 years. Main Outcome Measure.--Incident and fatal breast cancer. Results.--During 1 203498 person-years, 2517 incident breast cancers (60% postmenopausal) were documented. Higher current BMI was associated with lower breast cancer incidence before menopause and was minimally associated with incidence after menopause. However, a stronger positive relationship was seen among postmenopausal women who never used hormone replacement (relative risk=1.59 for BMI >31 kg/m[sup.2] vs is less than or equal to 20 kg/m[sup.2]; 95% confidence interval, 1.09-2.32; P for trend Conclusions.--Avoiding adult weight gain may contribute importantly to the prevention of breast cancer after menopause, particularly among women who do not use postmenopausal hormones. JAMA. 1997;278:1407-1411

There appears to be no association between caffeine consumption and coronary heart disease in women. Researchers analyzed the incidence of fatal and nonfatal heart attacks in 85,747 women participating in the Nurses' Health Study between 1980 and 1990. Since 1980, the women had been asked during their biennial surveys to estimate the amount of caffeine they consumed. During the study, there were 181 fatal and 567 nonfatal heart attacks in the group. After controlling for smoking and age, there was no association between caffeine consumption and heart attack. Women who drank 6 or more cups of coffee had no higher risk of heart attack than women who drank fewer cups. There was no association between heart attack and the consumption of decaffeinated coffee or the consumption of coffee before 1976, which was when the Nurses' Health Study was started. Prior to this time, many people drank unfiltered coffee, which may contain a fat-soluble chemical that could raise cholesterol levels.

Women with body weights in the upper-normal range and those who gain even modest amounts of weight during adulthood may have an increased risk of coronary heart disease (CHD). According to the 1990 U.S. weight guidelines, the desirable weight for women aged 35 and older ranges between 21 and 27 kilograms per meter squared of body height (kg m2). Between 1976 and 1990, researchers surveyed 115,818 women at two-year intervals to determine the affects of the women's medical histories and lifestyles on their risk for CHD. During the follow-up period, the women suffered 1,292 episodes of CHD. As the women's body mass increased, their risk of CHD increased. Even women with body masses between 25 and 28.9 kg m2 had more than two times the risk of CHD than women who weighed less than 21 kg m2. Women who gained at least five kg of weight after age 18 had a significantly higher risk of CHD than women who gained less than five kg after age 18.

Women who have a tubal ligation may have a lower risk of developing ovarian cancer than those who do not. A tubal ligation is a sterilization procedure that involves closing off the fallopian tubes by surgical tieing off. Among 77,544 female nurses who were premenopausal in 1976, 14% had a tubal ligation and 10% had a hysterectomy. The risk of ovarian cancer for those who had had a tubal ligation was about one-fourth that of those who had not. Their lower risk did not appear to be caused by screening of the ovaries at the time of the tubal ligation. Researchers also examined the effect of having a hysterectomy on the risk of developing ovarian cancer in premenopausal and postmenopausal female nurses. Women who had had a hysterectomy were slightly less likely to develop ovarian cancer. Their risk was about two-thirds that of women who had not had a hysterectomy., Objective.--To assess whether tubal ligation and hysterectomy affect subsequent risk of ovarian cancer. Design.--Prospective cohort study with 12 years of follow-up. Setting.--United States, multistate. Participants.--A total of 121 700 female registered nurses who were 30 to 55 years of age in 1976; the follow-up rate was 90% as of 1988. Main Outcome Measure.--Ovarian cancer of epithelial origin confirmed by medical record review. Results.--We observed a strong inverse association between tubal ligation and ovarian cancer, which persisted after adjustment for age, oral contraceptive use, parity, and other ovarian cancer risk factors (multivariate relative risk [RR], 0.33; 95% confidence interval [CI], 0.16 to 0.64). The association was similar when we assessed tubal ligation status at the baseline questionnaire and excluded cases in the first 4 years to eliminate any possible short-term decrease in risk due to screening of the ovaries during ligation surgery. We noted a weaker inverse association between simple hysterectomy and ovarian cancer (RR, 0.67; 95% CI, 0.45 to 1.00). Neither vasectomy nor condom use by a partner was associated with risk of ovarian cancer. Conclusions.--These data indicate that tubal ligation, and perhaps hysterectomy, may substantially reduce risk of epithelial ovarian cancer.

Women may have a higher risk of developing breast cancer if their mother or sister have had the disease. The increase in risk associated with a family history of breast cancer may be smaller than previously thought. Among 117,988 women between 30 and 55 years old in 1976 who were followed until 1988, 2,389 developed invasive breast cancer. The highest risk of breast cancer occurred among women whose mother was diagnosed with breast cancer before the age of 40. These women had twice the risk of developing breast cancer as women with no maternal history of breast cancer. The risk of breast cancer was also higher among women whose mother was diagnosed with breast cancer after the age of 70 or whose sister had breast cancer. However, only 2.5% of the women diagnosed with breast cancer had a family history of the disease., Objective.-To examine the risk of breast cancer as influenced by a maternal history of breast cancer, the mother's age of diagnosis, or a sister's history of breast cancer. Design.-Prospective cohort study with biennial follow-up. Setting/Participants.-117 988 women in the Nurses' Health Study aged 30 to 55 years in 1976, followed up through 1988 (1.3 million person-years of follow-up). Results.-We identified 2389 incident cases of invasive breast cancer. Compared with women without a maternal history of breast cancer, the age-adjusted relative risk (RR) of breast cancer was highest among women whose mother was diagnosed before the age of 40 years (RR, 2.1 [95% confidence interval, 1.6 to 2.8]). The RR decreased with advancing maternal age at time of diagnosis to 1.5 (95% confidence interval, 1.1 to 2.2) for maternal diagnosis after the age of 70 years. Having a sister with a history of breast cancer also was related to increased risk; for women with one sister with breast cancer compared with those with one sister without such a history, the age-adjusted RR was 2.3 (95% confidence interval, 1.6 to 3.4). Women whose mother and sister both had a history of breast cancer had an RR of 2.5 (95% confidence interval, 1.5 to 4.2) compared with those without a family history. These associations did not differ appreciably when stratified by age; menopausal status; history of benign breast disease; body mass index; age at menarche; or parity or age at first birth of the women at risk. The results remained unchanged when we controlled for these risk factors in multivariate models. despite slightly greater mammography surveillance and earlier detection of tumors among women with a family history of breast cancer, detection bias is unlike to account for more than a small part of the observed association. Conclusions.--Risk of breast cancer is approximately doubled among women whose mother had breast cancer diagnosed before the age of 40 years or who have a sister with breast cancer, and remains elevated even for those whose mothers were diagnosed with breast cancer at the age of 70 years or older. However, the risk associated with a mother or sister history of breast cancer is smaller than suggested by earlier retrospective studies. Overall, within this population of middle-aged women, only 2.5% of breast cancer cases are attributable to a positive family history. (JAMA. 1993;270:338-343)

Women who stop smoking may reduce their risk of stroke to that of a non-smoker within two to four years after they stop. Smoking is a known risk factor for stroke. Data on 117,006 women in the Nurses' Health Study show that 33% were smokers in 1976, compared to only 22% in 1988. During the 12-year follow-up, there were 448 strokes in the group. Smokers had almost three times the risk of stroke as those who never smoked, and their risk increased with the number of cigarettes they smoked daily. Among former smokers, the risk of a stroke dropped significantly so that by two to four years, their risk was only slightly higher than those who never smoked. This was especially true for ischemic strokes, which result when a blood clot lodges in an artery, cutting off the blood supply to the brain. Smoking is known to constrict arteries, which reduces blood flow, and increase platelet aggregation. This could lead to a higher risk of stroke in smokers., Objective. To prospectively examine the relationship of time since stopping smoking with risk of stroke in middle-aged women. Design.--An ongoing prospective cohort of women with 12 years' follow-up data (1976 to 1988), in which information on smoking habits was updated every 2 years by postal questionnaire. Population Studied.--A total of 117 006 female registered nurses aged 30 to 55 years in 1976 and free of coronary heart disease, stroke, and cancer at baseline. Main Outcome Measures.--Incident strokes (fatal and nonfatal), further subdivided into ischemic stroke, subarachnoid hemorrhage, and cerebral hemorrhage. Results. The age-adjusted relative risk of total stroke among current smokers compared with never smokers was 2.58 (95% confidence interval, 2.08 to 3.19). The corresponding relative risk among former smokers was 1.34 (95% confidence interval, 1.04 to 1.73). For total and ischemic stroke, the excess risks among former smokers largely disappeared from 2 to 4 years after cessation. The same patterns of decline were observed regardless of number of cigarettes smoked, the age at starting, or the presence of other risk factors for stroke. Conclusions.--The risk of suffering a stroke among cigarette smokers declines soon after cessation and the benefits are independent of the age at starting and the number of cigarettes smoked per day. (JAMA. 1993;269:232-236)

Women who reduce their fat intake may not necessarily reduce their risk of developing breast cancer. During an eight-year follow-up of 89,494 women in the Nurses' Health Study, 1,439 women developed breast cancer. There was no association between fat intake and the risk of developing breast cancer. This was true even in women who were postmenopausal. Women who consumed more than half their calories as fat were no more likely to develop breast cancer than those who consumed less than one-third their calories as fat. There was no association between the type of fat eaten and the risk of developing breast cancer. There was also no association between dietary fiber and the risk of developing breast cancer. Epidemiological studies have found low incidences of breast cancer in countries with low fat intake, but other dietary and life-style factors could be involved., Objective. -- To address the hypotheses that dietary fat increases and fiber decreases the risk of breast cancer. Design. -- Prospective cohort study with dietary assessment at baseline, using a balidated, self-administered food frequently questionnaire. Setting/Participants. -- 89 494 women in the Nurses' Health Study who were 34 through 59 years of age in 1980 and who were followed up for 8 years (>95% complete). Results. -- 1439 incident cases of breast cancer were diagnosed, including 774 among postmenopausal women. After adjustment for age, established risk factors, and total energy intake, we observed no evidence of any positive association between total fat intake and breast cancer incidence (relative risks [RRs] for increasing quintiles of fat intake were 1.0, 0.85, 0.96, 0.91, and 0.90; 95% confidence interval for highest vs lowest quintile, 0.77 to 1.07). Among postmenopausal women alone, corresponding RRs were 1.0, 0.89, 1.00, 0.95, and 0.91. Comparing extreme deciles of total fat intake (is greater than 49% vs Conclusions. -- These data provide evidence against both an adverse influence of fat intake and a protective effect of fiber consumption, by middle-aged women on breast cancer incidence over 8 years. Nevertheless, the positive association between intake of animal fat and risk of colon cancer observed in many studies provides ample reason to limit this source of energy.

Smoking increases the risk of cataracts, most specifically posterior subcapsular cataracts. A study of registered nurses ages 45 to 67 showed that women who smoked at least 65 pack years or greater had 63% increased risk of needing cataract surgery than did nonsmokers. They had 2.5 times the risk of posterior subcapsular cataract, a rare variety which causes symptoms early so making up a disproportionate number of surgical extractions. Risk did not decrease 10 years after quitting. This may be because older cells are compressed toward the center as new cells are produced rather than being replaced. The lens also has a limited ability to repair protein damage. The risk ratio increased by reducing intake of foods eaten with antioxidant vitamins. No studies to date explain if the effect of smoking is due to external smoke irritation or to a smoke constituent absorbed through the lungs., Objective.--To examine prospectively the association between cigarette smoking and the risk of cataract extraction in women. Design.--Prospective cohort study beginning in 1980 with 8 years of follow-up. Setting.--United States, multistate. Participants.--Registered nurses 45 to 67 years of age and free of diagnosed cancer. There were 50 828 women included in 1980 and others were added as they became 45 years of age. Main Outcome Measure.--Incidence of senile cataract extraction. Results.--We documented 493 incident senile cataracts diagnosed and extracted during 470 302 person-years of follow-up. The age-adjusted relative risk (RR) among women who smoked at least 65 pack-years was 1.63 (95% confidence interval [Cl], 1.18 to 2.26; P for trend, .02). A similar increase in RR was noted when smoking was assessed in terms of number of cigarettes currently smoked or number of cigarettes smoked by past smokers. Results were also similar after adjusting for other potential risk factors for cataract. Smoking was also strongly associated with posterior subcapsular cataract specifically (RR, 2.59; 95% Cl, 1.49 to 4.50 for [is greater than or equal to] 65-pack-year smokers relative to nonsmokers). Conclusion.--Smoking appears to increase the risk of cataract extraction. (JAMA. 1992;268:994-998)

Men who smoke more than 20 cigarettes daily have over twice the risk of cataracts than those who have never smoked. A study of 557 cataracts among 371 patients ages 40 to 84 showed significantly greater risk of nuclear sclerotic and posterior subcapsular cataracts among current smokers. Past smokers had greater risk of posterior subcapsular cataract but not nuclear sclerotic cataract. Posterior subcapsular cataracts are particularly disabling and occur more frequently than other types. A study of female nurses showed similar results. Although the mechanism is not clear, cigarette smoking may act indirectly by altering plasma concentrations of nutrients which are important to maintain lens transparency. Antioxidents may also contribute to cataract formation., Objective.--To examine the association between cigarette smoking and the incidence of cataract. Design, Setting, and Participants.--The design was a prospective cohort study using data from the Physicians' Health Study, a randomized trial of aspirin and beta carotene among 22 071 US male physicians aged 40 to 84 years that began in 1982. This analysis includes the 17 824 physicians who did not report cataract at baseline and did provide complete risk factor information. Based on information reported at baseline, 1 0% were current smokers, 39% were past smokers, and 51 % were never smokers. Main Outcome Measure.--An incident cataract was defined as a self-report confirmed by medical record review to have been first diagnosed after randomization, age-related in origin, and responsible for a decrease in best corrected visual acuity to 20/30 or worse. Main Results.--During 60 months of follow-up, 557 incident cataracts among 371 participants were confirmed. Compared with never smokers, current smokers of 20 or more cigarettes per day had a statistically significant increase in the risk of cataract (relative risk [RR], 2.16; 95% confidence interval [CI], 1.46 to 3.20; P

A number of studies have shown that aspirin can help reduce deaths and disease from cardiovascular events in patients who have had previous cardiovascular problems. However, these studies have not been able to determine whether aspirin affects women differently from men. Studies examining the preventive value of aspirin for people who have not yet had heart problems have had promising results, but these studies have only been performed on men. This study examined the effectiveness of aspirin taken on a regular basis in preventing first time cardiovascular events in women. Data regarding aspirin use and cardiovascular disease were obtained from the Nurses' Health Study. Questionnaires from 1980 to 1986 obtained from 87,678 women were examined. None of the women had prior histories of cardiovascular disease. The women were categorized by aspirin use and rates of cardiovascular events (e.g. heart attacks) were established for the various groups. Results showed that 40 percent of the women took aspirin on a regular basis. During the period of the study, there were 198 strokes, 81 deaths from heart disease, and 240 nonfatal heart attacks. For women that took one to six aspirins per week, there was a 32 percent reduction in the risk for a heart attack compared with those that did not take aspirin regularly. This reduction was not seen when the number of aspirin taken per week was seven or more. The reduced risk was not seen in women under the age of 50. The risk for stroke was not different among the groups. The risk for death from cardiovascular disease was lower, but not statistically significant, for the women who took one to six aspirins per week. These results indicate that aspirin taken on a regular basis may lower the risk of a first heart attack in women whose risk is high. Further studies using randomized trials are needed to confirm this finding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Data from several lines of investigation indicate that elevated levels of estrogen (a female hormone) are associated with breast cancer. Studies of the role of exogenous estrogen administered to women after menopause (estrogen replacement therapy) have investigated women with histories of estrogen use, but have not distinguished between current and past users. To learn more concerning this issue, data from the Nurses' Health Study were evaluated. The study is a prospective one that involved 121,700 female nurses aged 30 to 55 at its beginning in 1976. In that year, participants answered a questionnaire about risk factors for cancer and cardiovascular disease; follow-up questionnaires were sent in 1978, 1980, 1982 and 1984. Subjects' menopausal status and postmenopausal use of hormones (if applicable) were investigated. The women were classified as current, past, or never users of estrogen replacement therapy, and their breast cancer histories were investigated. Results from 367,187 woman-years of follow-up indicated that approximately 21 percent of this time was taken up by current users; 25 percent by past users; and 51 percent by subjects who had never undergone estrogen replacement therapy (information was missing for 4 percent of the participants). Current users had a relative risk (RR) of 1.36 of developing breast cancer, compared with never-users; past users' RR was 0.98. Factors that could have confounded the results are discussed. Overall, it appears that estrogen promotes the development of breast cancer, but the effect is small. The hormone has a beneficial effect on the risk of cardiovascular disease and hip fractures, which counterbalances its adverse effects on cancer risk. The picture of estrogen's effects is complex, and caution in its use should be observed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diet and energy intake are known to be associated with the incidence of mammary tumors in laboratory animals. The role of energy balance and body weight, particularly obesity, in the incidence of breast tumors is not clearly known. However, different risk rates obtained from various countries, and from the incidence rate fluctuations of populations who move from one country to another, point to a causal or etiologic role of diet in the development of breast cancer. The height and relative weight of 115,534 women who were 30 to 44 years old at the onset of this long-term study were recorded. At the time of their inclusion into the study all participants were known to be free of breast cancer. Eight years later, 648 premenopausal and 420 postmenopausal women had developed breast cancer. The risk of breast cancer in premenopausal woman was found to be statistically inversely related to their relative weight (weight adjusted for height), a measure of degree of body fat. (Less weight seems to be associated with an increased incidence of breast cancer.) A similar relationship was also found between the patients' weight at 18 years of age (as remembered and reported by the patient) and breast cancer. There was no significant relationship between weight at any age and cancer in postmenopausal women who developed breast cancer. Although thinner women have breast tumors discovered earlier and at a time when they are smaller and have better cure rates, the results in this study do not appear to be biased by such earlier detection. Adult obesity is generally associated with an increase risk of cancer. However, this study suggests that the rate of breast cancer in younger premenopausal woman may be reduced by obesity and that the risks of postmenopausal woman are only slightly affected by obesity., ABSTRACT: We examined relative weight and height in relation to subsequent breast cancer risk among 115534 women 30 to 55 years of age and free from cancer in 1976. By 1984, six hundred fifty-eight premenopausal and 420 postmenopausal breast cancers were documented during 734716 person-years. Among premenopausal women, risk of breast cancer decreased significantly with increasing relative weight (relative risk for the highest category was 0.6). A similar inverse association was seen for recalled relative weight at 18 years of age. Postmenopausal breast cancer was not associated with relative weight, either recent or at age 18. Height was not associated with breast cancer risk among premenopausal women and only weakly related among postmenopausal women. These data suggest that obesity among premenopausal and early postmenopausal women does not increase breast cancer risk substantially.

Importance: Prospective studies linking shift work to coronary heart disease (CHD) have been inconsistent and limited by short follow-up.Objective: To determine whether rotating night shift work is associated with CHD risk.Design, Setting, and Participants: Prospective cohort study of 189,158 initially healthy women followed up over 24 years in the Nurses' Health Studies (NHS [1988-2012]: N = 73,623 and NHS2 [1989-2013]: N = 115,535).Exposures: Lifetime history of rotating night shift work (≥3 night shifts per month in addition to day and evening shifts) at baseline (updated every 2 to 4 years in the NHS2).Main Outcomes and Measures: Incident CHD; ie, nonfatal myocardial infarction, CHD death, angiogram-confirmed angina pectoris, coronary artery bypass graft surgery, stents, and angioplasty.Results: During follow-up, 7303 incident CHD cases occurred in the NHS (mean age at baseline, 54.5 years) and 3519 in the NHS2 (mean age, 34.8 years). In multivariable-adjusted Cox proportional hazards models, increasing years of baseline rotating night shift work was associated with significantly higher CHD risk in both cohorts. In the NHS, the association between duration of shift work and CHD was stronger in the first half of follow-up than in the second half (P=.02 for interaction), suggesting waning risk after cessation of shift work. Longer time since quitting shift work was associated with decreased CHD risk among ever shift workers in the NHS2 (P<.001 for trend). [table: see text]Conclusions and Relevance: Among women who worked as registered nurses, longer duration of rotating night shift work was associated with a statistically significant but small absolute increase in CHD risk. Further research is needed to explore whether the association is related to specific work hours and individual characteristics. [ABSTRACT FROM AUTHOR]