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The prevalence of smoking is low among immigrants from El Salvador in the Washington DC metropolitan area, especially among the women. The smoking behaviour identified by this research almost exclusively represented the smoking patterns adopted by the Salvadoreans before migrating to the US. This research confirms previous findings that Hispanic women are much less likely to smoke than Hispanic men. There was found to be no connection between indices of socioeconomic status and smoking. This may reflect the more recent uptake of smoking that has taken place in El Salvador compared with the US.

Introduction: Identifying genetic factors associated with smoking cessation could inform precision cessation interventions. Of major interest is genetic variation in nicotine metabolism, largely predicted by CYP2A6 variations.Aims and Methods: We conducted a systematic literature review to summarize the population-based evidence of the association between CYP2A6 and smoking cessation. In the 12 studies meeting the inclusion criteria, the known functional metabolic effect of CYP2A6 variants was used to classify nicotine metabolism as normal (>75% metabolic activity), intermediate (50.1%-75% activity), slow (25%-50% activity), and poor (<25% activity). Summary odds ratios of smoking cessation were calculated across metabolic groups, stratified by ancestry and whether participants received pharmacotherapy or placebo/no treatment.Results: Among untreated people of European ancestry (n = 4 studies), those with CYP2A6 reduced metabolism were more likely to quit smoking than those with normal metabolism (Summary OR = 2.05, 95% CI 1.23 to 3.42) and the likelihood of cessation increased as nicotine metabolism decreased. Nicotine replacement therapy attenuated the association at end-of-treatment, while bupropion modified the association such that intermediate/slow metabolizers were less likely to quit than normal metabolizers (Summary OR = 0.86, 95% CI 0.79 to 0.94). Among untreated Asian people (n = 3 studies), results differed compared with those with European ancestry: those with slow metabolism were less likely to have quit smoking than normal metabolizers (Summary OR = 0.52, 95% CI 0.38 to 0.71). Evidence for people of African ancestry (n = 1 study) suggested the CYP2A6 association with cessation may differ compared with those of European ancestry.Conclusions and Implications: Most studies included in this review were of European ancestry populations; these showed slower nicotine metabolism was associated with increased likelihood of smoking cessation in a dose-related manner. Pharmacotherapy appeared to attenuate or modify this association among people of European ancestry, but it is unclear whether the change in the association remains consistent after treatment ceases. This finding has implications for precision medicine cessation interventions. Based on only a few studies of people of Asian or African ancestry, the association between CYP2A6 variants and cessation may differ from that observed among those of European ancestry, but more evidence is needed. [ABSTRACT FROM AUTHOR]

Background: Racial disparities in the uptake of cancer genetic services are well documented among African American (AA) women. Understanding the multiple social and psychological factors that can influence the uptake of genetic testing among AA women is needed.Methods: Data came from 270 AA women diagnosed with ovarian cancer and participating in a population-based, case-control study of ovarian cancer who were asked about genetic testing. Logistic regression analyses tested the associations of predisposing, enabling, and need factors with reported genetic testing uptake.Results: One-third of the sample (35%) reported having had genetic testing. In the multivariable model, AA women with higher incomes had more than double the odds of being tested than those with the lowest income (odds ratio [OR] for $25,000-$74,999, 2.04; 95% confidence interval [CI], 1.06-3.99; OR for ≥$75,000, 2.32; 95% CI, 0.92-5.94). AA women who reported employment discrimination were significantly less likely to report genetic testing than those who did not report job discrimination (OR, 0.39; 95% CI, 0.14-0.95). Marital status, Medicaid versus other insurance, prayer frequency, and perceived social support were significantly associated with genetic testing uptake in bivariate analyses but were not significant contributors in multivariable analyses.Conclusions: Consistent with other studies of AA women, a minority of African American Cancer Epidemiology Study participants had undergone genetic testing. Having a lower income and experiencing job discrimination decreased the likelihood of testing. These results provide foundational evidence supporting the need for interventions to improve the uptake of genetic testing among AA women by reducing cost barriers and providing credible assurances that genetic results will be kept private and not affect social factors such as employability. [ABSTRACT FROM AUTHOR]

An excess of male hormones in women may increase their risk of developing ovarian cancer. Researchers compared blood samples taken in 1974 from 31 women who subsequently developed ovarian cancer with those of 62 women who remained healthy (the control group). The women were among 20,305 residents of Washington County, MD, who contributed blood samples in 1974. The samples were tested for the female hormones luteinizing hormone, follicle-stimulating hormone, estrone and estradiol and the male hormones androstenedione and dehydroepiandrosterone (DHEA). The average blood level of male hormones was significantly higher in the women who developed ovarian cancer compared to the control group, and their average blood level of female hormones was significantly lower. Physicians should consider this possible effect of male hormones when prescribing hormone replacement therapy in women., Objective.--To prospectively examine the association between endogenous hormones and development of ovarian cancer. Design.--Nested case-control study. Setting.--A population-based serum bank in Washington County, Maryland. Participants.--Serum samples were collected in 1974 from 20 305 county residents and stored at -70[degrees]C. From 1975 through 1989, a total of 31 cases of ovarian cancer were identified in women who were not taking hommones at the time of blood collection. These cases were matched to 62 controls on age, menopausal status, and, for premenopausal women, number of days from the beginning of the last menstrual period. Main Outcome Measure.--Prediagnostic endogenous hormone levels of cases and controls were compared. Results.--Mean follicle-stimulating hormone levels were lower among cases (43.3 IU/L) compared with controls (54.4 IU/L) (P=.04), and increasing levels were associated with significantly lower risk (P for trend=.01), particularly among postmenopausal women. Luteinizing hormone levels were 9% lower among cases than controls, but the difference was not statistically significant (P=.39). Compared with controls, cases had higher androstenedione levels (4.5 nmol/L vs 3.3 nmol; P=.03) and higher dehydroepiandrosterone (DHEA) levels (15.9 nmol/L vs 9.7 nmol/L; P=.02). The risk of ovarian cancer increased with higher levels of androstenedione and DHEA sulfate (P for trend=.008 and .11, respectively). These associations were not materially different between premenopausal and postmenopausal women. Conclusion.--The results suggest that women with low serum gonadotropin levels or high androgen levels have an increased risk of ovarian cancer. These findings do not support the hypothesis that pituitary gonadotropins increase the risk of ovarian cancer. Replication of the study in other populations is highly desirable. (JAMA. 1995;274:192-1930)

Measuring levels of the tumor marker CA-125 does not appear to be a sensitive enough means of detecting ovarian cancer. CA-125 levels were monitored in 37 women diagnosed with ovarian cancer and in 73 healthy women who served as controls. CA-125 levels among the women with ovarian cancer did not vary significantly with the extent or duration of the disease. Sensitivity, which is the probability that a woman with ovarian cancer will be correctly identified, was only 24% using this technique. Specificity, which is the probability that a woman without ovarian cancer will be correctly identified, was 96%. Even if the specificity were 99% however, widespread screening would still result in too many false-positive results, raising health care costs and emotional anxiety among misdiagnosed women. Elevated levels of CA-125 were associated with a higher risk of ovarian cancer, but widespread screening using this procedure would cause up to 41% of women to be incorrectly classified as being at high risk for ovarian cancer., Objective.--To evaluate prospectively the sensitivity and specificity of serum CA-125 levels for the detection of ovarian cancer. Design.--Case-control study nested within a cohort of women who donated blood to a community-based serum bank established in 1974. Setting.--Washington County, Maryland. Population.--Cases consisted of 37 women who developed ovarian cancer from 1975 through 1989. Controls consisted of 73 women, matched on age and time since last menstrual period, and free of cancer until the cases&apos; diagnoses. Study Variable.--Serum CA-125 levels. Outcome Measure.--Histologically confirmed ovarian cancer. Results.--Levels of serum CA-125 among cases were higher than among controls for each 3-year interval up to 12 years prior to the time of the cases&apos; diagnoses. The median level for cases diagnosed within the first 3 years of follow-up was 35.4 U/mL compared with 9.0 U/mL for controls (P=.002). The sensitivity of a serum CA-125 level greater than 35 U/mL within the first 3 years was 57% (95% confidence interval, 20% to 88%) and the specificity was 100% (95% confidence interval lower limit, 73%). Sensitivity and specificity decreased with increasing time to diagnosis. Conclusions.--Measurement of serum CA-125 levels, particularly at a reference value of 35 U/mL, is not sufficiently sensitive to be used alone as a screening test for the detection of ovarian cancer. Lower CA-125 reference values could identify women at higher risk of developing ovarian cancer, but CA-125 measurement cannot be recommended for this purpose because of the high proportion of women who would be falsely classified as being at high risk for developing ovarian cancer.