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Bilateral oophorectomy is often performed during hysterectomy for benign conditions and can reduce breast cancer risk by 20%-50% when performed at younger ages. Accuracy of estimating the decrease in breast cancer risk associated with bilateral oophorectomy could be affected by common conditions that lead to surgery, such as uterine fibroids or endometriosis. The authors examined the potential for confounding by nonmalignant indications for surgery on breast cancer risk estimates in a population-based case-control study of invasive breast cancer newly diagnosed in 1992-1995. Breast cancer cases (N = 4,935) aged 50-79 years were identified from Wisconsin, Massachusetts, and New Hampshire tumor registries; similarly aged controls (N = 5,111) were selected from driver's license and Medicare lists. Reproductive and medical history was obtained from structured telephone interviews. Odds ratios and 95% confidence intervals were estimated with multivariate logistic regression. Women who underwent bilateral oophorectomy with hysterectomy at age ≤ 40 years had significantly reduced odds of breast cancer (odds ratio = 0.74, 95% confidence interval: 0.60, 0.90) compared with women with intact ovaries and uterus. Effect estimates were virtually unchanged after adjustment for uterine fibroids or endometriosis history. Results indicate that breast cancer risk reductions conferred by bilateral oophorectomy are not strongly confounded by failure to account for nonmalignant indications for surgery.

Women with ductal carcinoma in situ (DCIS) of the breast represent a growing cancer survivor population with a diagnosis of uncertain malignant potential. These survivors face an absence of scientific guidelines regarding lifestyle changes that can help to prevent a breast cancer recurrence. In this first report from the Wisconsin In Situ Cohort (WISC) study, we examine how women are currently changing their lifestyle behaviors and medication use following a diagnosis of DCIS. At study entry (1997-2006), 1,959 subjects (78% of eligible) with DCIS were identified from the Wisconsin cancer registry and administered an interview assessing behaviors prior to diagnosis. Follow-up interviews were completed every 2 years after the initial interview, beginning in 2003 and continuing through 2006. After adjusting for age and calendar year, women were 2.2 kg (95% CI 1.4, 3.0) heavier, 35% (95% CI 20, 47) less likely to be a smoker, 19% (95% CI -1, 43) more likely to use non-steroidal anti-inflammatory drugs, and 57% (95% CI 26, 95) more likely to use antidepressants after a DCIS diagnosis compared to 1 year prior to diagnosis. Use of postmenopausal hormones decreased sharply (OR = 0.06; 95% CI 0.04, 0.09) following a DCIS diagnosis. These findings indicate that women make substantial changes in their behaviors after a DCIS diagnosis. This cohort will be further monitored to evaluate the association between these behaviors and health outcomes following DCIS.

Background: Factors related to improving outcomes in breast cancer survivors are of increasing public health significance. We examined postdiagnosis weight change in relation to mortality risk in a cohort of breast cancer survivors., Methods: We analyzed data from a cohort of 3,993 women with ages 20 to 79 years living in New Hampshire, Massachusetts, or Wisconsin with invasive nonmetastatic breast cancers diagnosed in 1988 to 1999 identified through state registries. Participants completed a structured telephone interview 1 to 2 years after diagnosis and returned a mailed follow-up questionnaire in 1998 to 2001 that addressed postdiagnosis weight and other factors. Vital status information was obtained from the National Death Index through December 2005. Hazard ratios and 95% confidence intervals were estimated from Cox proportional hazards models and adjusted for prediagnosis weight, age, stage, smoking, physical activity, and other important covariates., Results: During an average 6.3 years of follow-up from the postdiagnosis questionnaire, we identified 421 total deaths, including 121 deaths from breast cancer and 95 deaths from cardiovascular disease. Increasing postdiagnosis weight gain and weight loss were each associated with greater all-cause mortality. Among women who gained weight after breast cancer diagnosis, each 5-kg gain was associated with a 12% increase in all-cause mortality (P = 0.004), a 13% increase in breast cancer-specific mortality (P = 0.01), and a 19% increase in cardiovascular disease mortality (P = 0.04). Associations with breast cancer mortality were not modified by prediagnosis menopausal status, cigarette smoking, or body mass index., Conclusion: These findings suggest that efforts to minimize weight gain after a breast cancer diagnosis may improve survival.

Background: Early life risk factors for breast cancer have been investigated in relation to hormonal, nutritional, infectious, and genetic hypotheses. Recent studies have also considered potential health effects associated with exposure to environmental contaminants in breastmilk., Methods: We analyzed data from a population-based case-control study of women living in Wisconsin. Cases (n = 2016) had an incident diagnosis of invasive breast cancer in 2002-2006 reported to the statewide tumor registry. Controls (n = 1960) of similar ages were randomly selected from driver's license lists. Risk-factor information was collected during structured telephone interviews. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from multivariable logistic regression., Results: In multivariable models, maternal age and birth order were not associated with breast cancer risk in the full study population. The odds ratio for breast cancer risk associated with having been breast-fed in infancy was 0.83 (95% CI = 0.72-0.96). In analyses restricted to breast-fed women, maternal age associations with breast cancer were null (P = 0.2). Increasing maternal age was negatively associated with breast cancer risk among women who were not breast-fed; the odds ratio for breast cancer associated with each 5-year increase in maternal age was 0.90 (0.82-1.00). Higher birth order was inversely associated with breast cancer risk among breast-fed women (for women with 3 or more older siblings compared with first-born women, OR = 0.58 [CI = 0.39-0.86]) but not among nonbreast-fed women (1.13 [0.81-1.57])., Conclusion: These findings suggest that early life risk factor associations for breast cancer may differ according to breast-feeding status in infancy.

Background: We evaluated students' perception of cancer causation among sixth-grade girls living in Wisconsin., Method: We asked female students to list up to 3 causes of cancer in a cross-sectional health survey., Results: A total of 141 answers were given by 53 students. The most frequently listed causes of cancer were cigarette smoking (91%), drugs (32%), an unhealthy diet (25%), and heredity (25%). Less than 10% of students listed other potentially modifiable risk factors such as exercise, sun exposure, or alcohol consumption., Conclusion: Students in this study appeared to link a range of high-risk behaviors with health consequences, although the specific health risks may not be understood.

We conducted a cross-sectional, school-based survey of sixth-grade girls living in the Reedsburg, Wis area school district to explore factors associated with age at menarche. Data collection included parent and student questionnaires for demographic, menstrual, physical activity, and nutritional information. School nurses conducted physical examinations to provide anthropometric measurements. Salivary samples were obtained for laboratory analysis of estradiol, estrone, estriol, and progesterone levels. Students (n=59) were an average of 11.9 years of age (range: 10-13). Nineteen students (32%) reported menarche, with an average of 11.4 years of age (range: 8-12). Cycle length of the menstruating students averaged 32.0 days (range: 25-46 days). Students' age at menarche was positively correlated with their mothers' age at menarche (r=0.53, P=0.02). Total caloric intake, macronutrients, hormone levels, birthweight, and family size were not associated with menstrual status. We observed an inverse association between increasing weight and earlier age at menarche (P=0.03). Students past menarche watched more television (P=0.03) and participated in fewer hours of sporting activity (P=0.08) than students who had not yet reached menarche. These preliminary data suggest that further investigation of the determinants of menarche is both feasible and warranted.

We investigated the association of oral contraceptive (OC) use and reproductive factors with colorectal cancer risk in a large population-based case-control study. Cases were women ages 20 to 74 years, living in Wisconsin, with a new diagnosis of colon (n = 1,122) or rectal (n = 366) cancer. Control participants were randomly selected from population lists of similarly aged female Wisconsin residents (n = 4,297). Risk factor information was collected through structured telephone interviews. Compared with never users, OC users had an odds ratio (OR) of 0.89 [95% confidence interval (95% CI), 0.75-1.06] for colorectal cancer. OC use associations did not differ significantly between colon and rectal cancer sites; however, when compared with never users, recent OC users (<14 years) seemed at reduced risk of rectal cancer (OR, 0.53; 95% CI, 0.28-1.00). Women with age at first birth older than the median (23 years) had 0.83 times the risk of colon cancer compared with women with age at first birth below the median (95% CI, 0.70-0.98). We observed an inverse trend between increasing parity and rectal cancer risk (P = 0.05). Compared with nulliparous women, women with five or more births had 0.66 times the risk of rectal cancer (95% CI, 0.43-1.02). Compared with postmenopausal women, premenopausal women were at reduced risk (OR, 0.67; 95% CI, 0.47-0.97) of colorectal cancer. No significant associations were observed between colorectal cancer risk and age at menarche or age at menopause. These findings suggest differential roles of reproductive factors in colon and rectal cancer etiology.