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Epplein, Meira

Overview:

Meira Epplein is a cancer epidemiologist interested in modifiable risk factors in under-served populations, with a focus on the association of infection and cancer.  She became Co-Leader of Cancer Control and Population Sciences at Duke Cancer Institute and Associate Professor of Population Health Sciences in the Duke University Medical Center in May of 2017.  Previously, she was a tenured faculty member at Vanderbilt University Medical Center, after two years as a post-doctoral fellow with the Multiethnic Cohort Study at the University of Hawaii.  Prior to earning her PhD in epidemiology from the University of Washington, she completed an MA in international studies, and spent five years as a program officer for the Asian research think tank, the National Bureau of Asian Research.


Dr. Epplein’s research program has centered around the bacteria Helicobacter pylori, a spiral, gram-negative bacterium that infects approximately 50% of the world’s population, and is the leading carcinogenic infectious agent according to the International Agency for Research on Cancer.  Her research seeks to understand the heterogeneity of H. pylori, to determine the most toxigenic forms of the bacteria so to identify the highest risk populations which can then be targeted for antibiotic therapy, which has been shown to be effective for risk reduction. At the same time, she is committed to furthering our understanding of the co-factors involved in both H. pylori-associated disease risk and benefit, as the bacteria has inhabited the stomachs of humans for over 100,000 years, and so very likely also confers certain biological advantages to its hosts.


As Principal Investigator, she has obtained three large NIH-funded grants to further explore the epidemiology of H. pylori heterogeneity: a 5-year career development award (K07) from NCI that focuses on infection, inflammation, and cancer; a 5-year R01 from NCI to develop an H. pylori blood biomarker for gastric cancer risk in East Asia; and a 4-year R01, again funded by NCI, to further investigate, in a large consortium of prospective cohorts across the United States, the novel preliminary finding of H. pylori protein-specific antibodies and the risk of colorectal cancer. She also serves as a Co-Investigator and lead gastric cancer and H. pylori researcher for the Southern Community Cohort Study (SCCS). In addition to serving as a standing member of the study section NCI Subcommittee J (Career Development Awards), she is an editorial board member of the journal Cancer Epidemiology, Biomarkers & Prevention, and is co-chair of the 2017 American Society of Preventive Oncology Annual Meeting Program Committee. 

Area of expertise: Epidemiology

Positions:

Instructor in the Department of Population Health Sciences

Population Health Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.A. 1997

M.A. — University of Washington

M.S. 2005

M.S. — University of Washington

Ph.D. 2007

Ph.D. — University of Washington

Grants:

Helicobacter pylori protein-specific and colorectal cancer risk

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
May 01, 2017
End Date
April 30, 2019

Helicobacter pylori blood biomarker for gastric cancer risk in East Asia

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 2017
End Date
June 30, 2018

Publications:

A Prospective Study of Urinary Prostaglandin E2 Metabolite, Helicobacter pylori Antibodies, and Gastric Cancer Risk.

Previous studies suggest that a stable end-product of prostaglandin E2, the urinary metabolite PGE-M, is associated with colorectal cancer, and 1 study of relatively small sample size found an association with gastric cancer among women. In the present study we further investigate the PGE-M, Helicobacter pylori, and gastric cancer association.The present analysis included 359 prospectively ascertained gastric cancer cases and 700 individually matched controls from the Shanghai Women's and Men's Health Studies. Urinary PGE-M was measured by a liquid chromatography/tandem mass spectrometric method. Seropositivity to 15 H. pylori recombinantly expressed fusion proteins was detected by H. pylori multiplex serology.Adjusting for H. pylori, increasing PGE-M was associated with higher risk of gastric cancer (quartile 4 vs 1: odds ratio [OR], 1.76 [95% confidence interval {CI}, 1.17-2.66], Ptrend = .004). This association remained after excluding those diagnosed within 2 years from sample collection (OR, 1.73 [95% CI, 1.12-2.65], Ptrend = .007). However it was no longer present among individuals with 10 or more years of follow-up (2-4.9 years: OR, 3.15 [95% CI, 1.11-8.91]; 5-9.9 years: OR, 2.23 [95% CI, 1.22-4.06]; ≥10 years: OR, 0.73 [95% CI, .31-1.70]). Compared to H. pylori-negative individuals with below-median PGE-M levels, H. pylori-positive individuals with above-median PGE-M levels had a 5-fold increase in the odds of gastric cancer (OR, 5.08 [95% CI, 2.47-10.43]).In China, higher PGE-M levels may indicate an increased risk of gastric cancer independent of the risk conferred by H. pylori infection status, particularly for cancers diagnosed within 10 years of sample collection.

Authors
Wang, T; Cai, H; Zheng, W; Michel, A; Pawlita, M; Milne, G; Xiang, Y-B; Gao, Y-T; Li, H-L; Rothman, N; Lan, Q; Shu, X-O; Epplein, M
MLA Citation
Wang, T, Cai, H, Zheng, W, Michel, A, Pawlita, M, Milne, G, Xiang, Y-B, Gao, Y-T, Li, H-L, Rothman, N, Lan, Q, Shu, X-O, and Epplein, M. "A Prospective Study of Urinary Prostaglandin E2 Metabolite, Helicobacter pylori Antibodies, and Gastric Cancer Risk." Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 64.10 (May 2017): 1380-1386.
PMID
28402440
Source
epmc
Published In
Clinical Infectious Diseases
Volume
64
Issue
10
Publish Date
2017
Start Page
1380
End Page
1386
DOI
10.1093/cid/cix106

Fruit and vegetable consumption, Helicobacter pylori antibodies, and gastric cancer risk: A pooled analysis of prospective studies in China, Japan, and Korea.

Epidemiological findings on the association between fruit and vegetable consumption and gastric cancer risk remain inconsistent. The present analysis included 810 prospectively ascertained non-cardia gastric cancer cases and 1,160 matched controls from the Helicobacter pylori Biomarker Cohort Consortium, which collected blood samples, demographic, lifestyle, and dietary data at baseline. Conditional logistic regression adjusting for total energy intake, smoking, and H. pylori status, was applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for gastric cancer risk across cohort- and sex-specific quartiles of fruit and vegetable intake. Increasing fruit intake was associated with decreasing risk of non-cardia gastric cancer (OR = 0.71, 95% CI: 0.52-0.95, p trend = 0.02). Compared to low-fruit consumers infected with CagA-positive H. pylori, high-fruit consumers without evidence of H. pylori antibodies had the lowest odds for gastric cancer incidence (OR = 0.12, 95% CI: 0.06-0.25), whereby the inverse association with high-fruit consumption was attenuated among individuals infected with CagA-positive H. pylori (OR = 0.82, 95% CI: 0.66-1.03). To note, the small number of H. pylori negative individuals does influence this finding. We observed a weaker, nondose-response suggestion of an inverse association of vegetable intake with non-cardia gastric cancer risk. High fruit intake may play a role in decreasing risk of non-cardia gastric cancer in Asia.

Authors
Wang, T; Cai, H; Sasazuki, S; Tsugane, S; Zheng, W; Cho, ER; Jee, SH; Michel, A; Pawlita, M; Xiang, Y-B; Gao, Y-T; Shu, X-O; You, W-C; Epplein, M
MLA Citation
Wang, T, Cai, H, Sasazuki, S, Tsugane, S, Zheng, W, Cho, ER, Jee, SH, Michel, A, Pawlita, M, Xiang, Y-B, Gao, Y-T, Shu, X-O, You, W-C, and Epplein, M. "Fruit and vegetable consumption, Helicobacter pylori antibodies, and gastric cancer risk: A pooled analysis of prospective studies in China, Japan, and Korea." International journal of cancer 140.3 (February 2017): 591-599.
PMID
27759938
Source
epmc
Published In
International Journal of Cancer
Volume
140
Issue
3
Publish Date
2017
Start Page
591
End Page
599
DOI
10.1002/ijc.30477

Abstract LB-361: Serology of Streptococcus gallolyticus subsp. gallolyticus and risk of colorectal cancer

Authors
Butt, J; Pawlita, M; Epplein, M
MLA Citation
Butt, J, Pawlita, M, and Epplein, M. "Abstract LB-361: Serology of Streptococcus gallolyticus subsp. gallolyticus and risk of colorectal cancer." July 15, 2016.
Source
crossref
Published In
Cancer Research
Volume
76
Issue
14 Supplement
Publish Date
2016
Start Page
LB-361
End Page
LB-361
DOI
10.1158/1538-7445.AM2016-LB-361

Abstract 1735: Fruit and vegetable consumption and risk of gastric cancer: a prospective nested case-control study in China, Japan and Korea

Authors
Wang, T; Cai, H; Sasazuki, S; Tsugane, S; Zheng, W; Cho, ER; Jee, SH; Michel, A; Pawlita, M; Xiang, Y-B; Gao, Y-T; Shu, X-O; You, W; Epplein, M
MLA Citation
Wang, T, Cai, H, Sasazuki, S, Tsugane, S, Zheng, W, Cho, ER, Jee, SH, Michel, A, Pawlita, M, Xiang, Y-B, Gao, Y-T, Shu, X-O, You, W, and Epplein, M. "Abstract 1735: Fruit and vegetable consumption and risk of gastric cancer: a prospective nested case-control study in China, Japan and Korea." July 15, 2016.
Source
crossref
Published In
Cancer Research
Volume
76
Issue
14 Supplement
Publish Date
2016
Start Page
1735
End Page
1735
DOI
10.1158/1538-7445.AM2016-1735

Helicobacter pylori blood biomarker for gastric cancer risk in East Asia.

Incidence and mortality rates for gastric cancer, the fifth most commonly diagnosed and third most deadly cancer worldwide, are highest in East Asia. We sought to identify gastric cancer risk biomarkers among eight prospective studies from China, Japan and Korea.This pooled nested case-control study included 1608 incident non-cardia gastric cancer cases and 1958 matched controls. Pre-diagnostic antibody levels to 15 Helicobacter pylori proteins were assessed using multiplex serology. Conditional logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).Sero-positivity to 10 H. pylori antigens (Omp, CagA, VacA, HcpC, HP 0305, GroEL, NapA, HyuA, Cad, HpaA) was associated with a 1.29- to 3.26-fold increase in odds of gastric cancer. Omp and HP 0305 consistently remained associated with gastric cancer risk after mutually adjusting for all other markers. Sero-positivity to both Omp and HP 0305 was associated with an over 4-fold increase in gastric cancer incidence (OR, 4.09; 95% CI 3.26-5.13). When limited to only those who are CagA+ H. pylori+, Omp/HP 0305 sero-positivity remained strongly associated with an over 3-fold increase in the odds of gastric cancer (OR, 3.34; 95% CI 2.27-4.91). The results were highly consistent among the cohorts.We have confirmed new H. pylori biomarkers that are strongly associated with gastric cancer risk, even among those infected with the known H. pylori virulence factor CagA. These results may help to design cost-efficient prevention strategies to reduce gastric cancer incidence in East Asia.

Authors
Cai, H; Ye, F; Michel, A; Murphy, G; Sasazuki, S; Taylor, PR; Qiao, Y-L; Park, SK; Yoo, K-Y; Jee, SH; Cho, ER; Kim, J; Chen, S-C; Abnet, CC; Tsugane, S; Cai, Q; Shu, X-O; Zheng, W; Pawlita, M; Epplein, M
MLA Citation
Cai, H, Ye, F, Michel, A, Murphy, G, Sasazuki, S, Taylor, PR, Qiao, Y-L, Park, SK, Yoo, K-Y, Jee, SH, Cho, ER, Kim, J, Chen, S-C, Abnet, CC, Tsugane, S, Cai, Q, Shu, X-O, Zheng, W, Pawlita, M, and Epplein, M. "Helicobacter pylori blood biomarker for gastric cancer risk in East Asia." International journal of epidemiology 45.3 (June 2016): 774-781.
PMID
27170766
Source
epmc
Published In
International Journal of Epidemiology
Volume
45
Issue
3
Publish Date
2016
Start Page
774
End Page
781
DOI
10.1093/ije/dyw078

Population-based cohort studies of type 2 diabetes and stomach cancer risk in Chinese men and women.

Although positive associations have been found for diabetes and a number of cancer sites, investigations of stomach cancer are limited and the results lack consistency. In this prospective study we investigated the relationship between type 2 diabetes mellitus (T2DM) and stomach cancer risk in mainland China. We assessed the associations among T2DM, T2DM duration, and stomach cancer risk in two prospective population-based cohorts, the Shanghai Women's Health Study and the Shanghai Men's Health Study. Included in the study were 61 480 men and 74 941 women. Stomach cancer cases were identified through annual record linkage to the Shanghai Cancer Registry, and verified through home visits and review of medical charts. After a median follow-up of 7.5 years for the Shanghai Men's Health Study and 13.2 years for the Shanghai Women's Health Study, a total of 755 incident cases of stomach cancer (376 men and 379 women) were identified through to September 2013. Overall, we did not find any evidence that T2DM was associated with an increased risk of stomach cancer either in men (multi-adjusted hazard ratio = 0.83, 95% confidence interval, 0.59-1.16) or in women (multi-adjusted hazard ratio = 0.92, 95% confidence interval, 0.68-1.25). Our findings from two large prospective population-based cohorts suggest that T2DM was not associated with stomach cancer risk.

Authors
Xu, H-L; Tan, Y-T; Epplein, M; Li, H-L; Gao, J; Gao, Y-T; Zheng, W; Shu, X-O; Xiang, Y-B
MLA Citation
Xu, H-L, Tan, Y-T, Epplein, M, Li, H-L, Gao, J, Gao, Y-T, Zheng, W, Shu, X-O, and Xiang, Y-B. "Population-based cohort studies of type 2 diabetes and stomach cancer risk in Chinese men and women." Cancer science 106.3 (March 2015): 294-298.
PMID
25557005
Source
epmc
Published In
Cancer Science
Volume
106
Issue
3
Publish Date
2015
Start Page
294
End Page
298
DOI
10.1111/cas.12597

Challenges and opportunities in international molecular cancer prevention research: An ASPO Molecular Epidemiology and the Environment and International Cancer Prevention Interest Groups Report.

The International Agency for Research on Cancer estimates that over half of the new cancer cases and almost two-thirds of the cancer deaths in 2012 occurred in low and middle income countries. To discuss the challenges and opportunities to reducing the burden of cancer worldwide, the Molecular Epidemiology and the Environment and the International Issues in Cancer Special Interest Groups joined forces to hold a session during the 38th Annual Meeting of the American Society of Preventive Oncology (March 2014, Arlington, Virginia). The session highlighted three topics of particular interest to molecular cancer prevention researchers working internationally, specifically: 1) biomarkers in cancer research; 2) environmental exposures and cancer; and 3) molecular pathological epidemiology. A major factor for successful collaboration illuminated during the discussion was the need for strong, committed, and reliable international partners. A key element of establishing such relationships is to thoroughly involve individual international collaborators in the development of the research question; engaged international collaborators are particularly motivated to champion and shepherd the project through all necessary steps, including issues relating to institutional review boards, political sensitivity, laboratory-based assays, and tumor subtyping. Also essential is allotting time for the building, maintaining, and investing in such relationships so that successful international collaborations may take root and bloom. While there are many challenges inherent to international molecular cancer research, the opportunities for furthering the science and prevention of cancer worldwide are great, particularly at this time of increasing cancer incidence and prevalence in low and middle income countries.

Authors
Epplein, M; Bostick, RM; Mu, L; Ogino, S; Braithwaite, D; Kanetsky, PA
MLA Citation
Epplein, M, Bostick, RM, Mu, L, Ogino, S, Braithwaite, D, and Kanetsky, PA. "Challenges and opportunities in international molecular cancer prevention research: An ASPO Molecular Epidemiology and the Environment and International Cancer Prevention Interest Groups Report." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 23.11 (November 2014): 2613-2617.
PMID
25277796
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
23
Issue
11
Publish Date
2014
Start Page
2613
End Page
2617
DOI
10.1158/1055-9965.epi-14-0848

A prospective study of plasma Selenoprotein P and lung cancer risk among low-income adults.

Epidemiologic studies have shown increased risks of lung cancer among adults with low blood levels of selenium, although evidence is inconsistent. In the United States, the incidence of lung cancer is higher and mean serum selenium levels lower among Blacks than Whites, but prior studies have not assessed the selenium-lung cancer association among Blacks.From the prospective Southern Community Cohort Study, we identified 372 participants who provided blood samples and subsequently developed lung cancer. Selenoprotein P (SEPP1), the most abundant selenoprotein in plasma and a biomarker of selenium nutriture, was measured in the plasma from these individuals and from 716 matched controls.Mean SEPP1 levels were significantly (P < 0.0001) lower among Blacks than Whites. Conditional logistic regression models accounting for smoking revealed a significant trend of increasing OR of lung cancer with decreasing SEPP1 tertiles among Blacks (P = 0.0006) but not Whites (P = 0.69; Pinteraction = 0.10). The ORs and corresponding 95% confidence intervals of lung cancer risk among those with lowest versus highest tertile levels of SEPP1 were 2.4 (1.5-3.0) among Blacks and 1.1 (0.6-2.1) among Whites.Among a mostly low-income population in the southeastern United States, lower levels of SEPP1 were associated with an increasing risk of lung cancer among Blacks but not Whites.The combined findings of higher prevalence of low selenium status and higher lung cancer risk associated with low status raise the possibility that selenium deficiency may contribute to observed racial disparities in lung cancer incidence.

Authors
Epplein, M; Burk, RF; Cai, Q; Hargreaves, MK; Blot, WJ
MLA Citation
Epplein, M, Burk, RF, Cai, Q, Hargreaves, MK, and Blot, WJ. "A prospective study of plasma Selenoprotein P and lung cancer risk among low-income adults." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 23.7 (July 2014): 1238-1244.
PMID
24762559
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
23
Issue
7
Publish Date
2014
Start Page
1238
End Page
1244
DOI
10.1158/1055-9965.epi-13-1308

Helicobacter pylori Biomarkers and Risk of Colorectal Oncogenesis--Response.

Authors
Epplein, M; Peek, RM; Blot, WJ
MLA Citation
Epplein, M, Peek, RM, and Blot, WJ. "Helicobacter pylori Biomarkers and Risk of Colorectal Oncogenesis--Response." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 23.2 (February 2014): 366-. (Letter)
PMID
24285842
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
23
Issue
2
Publish Date
2014
Start Page
366
DOI
10.1158/1055-9965.epi-13-1191

Diet, Helicobacter pylori strain-specific infection, and gastric cancer risk among Chinese men.

Evidence for the association of diet and gastric cancer is equivocal, and the majority of previous studies have not evaluated the interaction of diet and infection with Helicobacter pylori, the leading risk factor for gastric cancer. We examined these associations among 226 cases and 451 controls nested within a prospective cohort. Dietary intakes were calculated from validated food frequency questionnaires. Blood levels of 15 antibodies to Helicobacter pylori proteins were assessed using multiplex serology. Odds ratios (ORs) were calculated using logistic regression. Among individuals infected with high-risk Helicobacter pylori (sero-positivity to 5-6 virulent H. pylori proteins), increasing intake of red meat, heme iron, and sodium increased risk (comparing highest tertile to lowest: ORs [95% confidence interval {CI}]: 1.85 [1.01-3.40]; 1.95 [1.06-3.57]; and 1.76 [0.91-3.43], respectively) while increasing intake of fruit decreased gastric cancer risk (comparing highest tertile of intake to lowest: OR [95% CI]: 0.52 [0.28-0.94]). No associations of diet with risk were found among individuals infected with low-risk H. pylori (P for interaction for red meat and sodium: 0.02 and 0.01, respectively). In this population with over 90% prevalence of CagA-positive H. pylori infection, categorizing individuals using H. pylori multiplex serology may identify individuals for whom a diet intervention may be effective.

Authors
Epplein, M; Zheng, W; Li, H; Peek, RM; Correa, P; Gao, J; Michel, A; Pawlita, M; Cai, Q; Xiang, Y-B; Shu, X-O
MLA Citation
Epplein, M, Zheng, W, Li, H, Peek, RM, Correa, P, Gao, J, Michel, A, Pawlita, M, Cai, Q, Xiang, Y-B, and Shu, X-O. "Diet, Helicobacter pylori strain-specific infection, and gastric cancer risk among Chinese men." Nutrition and cancer 66.4 (January 2014): 550-557.
PMID
24666234
Source
epmc
Published In
Nutrition and Cancer
Volume
66
Issue
4
Publish Date
2014
Start Page
550
End Page
557
DOI
10.1080/01635581.2014.894096

Circulating cytokines and gastric cancer risk.

Chronic inflammation has been hypothesized to play a significant role in the aetiology of cancer, including gastric cancer. In the present study, we sought to examine pre-diagnostic systemic cytokine levels in plasma, which can be seen as markers of aggregate inflammation, and risk of distal gastric cancer in a case-control study nested within the prospective Shanghai Men's Health Study.Circulating levels of eight inflammation-related cytokines were measured in the plasma collected at baseline for 180 incident cases of distal gastric cancer and 358 matched controls. Helicobacter pylori sero-positivity was assessed using multiplex serology. Conditional logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CI).Individuals with IL-8 levels above the lowest quartile were at twofold increased odds of gastric cancer [OR 1.91 (95 % CI 1.05-3.46), OR 2.10 (95 % CI 1.19-3.74), and OR 2.30 (95 % CI 1.26-4.19), for the second through fourth quartiles, respectively]. While there were suggestions of an increase in risk with increased level of many of the other cytokines measured (IL-1β, IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ), no significant associations were found at the p < 0.05 level. Infection with CagA-positive H. pylori did not modify these associations.In a population with high gastric cancer incidence and high H. pylori prevalence, increased circulating levels of IL-8 may indicate increased risk of gastric cancer. These findings add to our understanding of the disease and further efforts to uncover biomarkers of disease risk.

Authors
Epplein, M; Xiang, Y-B; Cai, Q; Peek, RM; Li, H; Correa, P; Gao, J; Wu, J; Michel, A; Pawlita, M; Zheng, W; Shu, X-O
MLA Citation
Epplein, M, Xiang, Y-B, Cai, Q, Peek, RM, Li, H, Correa, P, Gao, J, Wu, J, Michel, A, Pawlita, M, Zheng, W, and Shu, X-O. "Circulating cytokines and gastric cancer risk." Cancer causes & control : CCC 24.12 (December 2013): 2245-2250.
PMID
24052422
Source
epmc
Published In
Cancer Causes & Control
Volume
24
Issue
12
Publish Date
2013
Start Page
2245
End Page
2250
DOI
10.1007/s10552-013-0284-z

Helicobacter pylori protein-specific antibodies and risk of colorectal cancer.

There is biologic plausibility as to why infection with Helicobacter pylori, the leading cause of gastric cancer, may also increase the risk of colorectal cancer, but the epidemiologic findings have been inconsistent. We assessed the association of H. pylori protein-specific infection and colorectal cancer risk in the prospective cohort, the Southern Community Cohort Study.Multiplex serology was used to measure antibodies to 15 H. pylori proteins in prediagnostic blood among 188 incident colorectal cancer cases and 370 controls matched by age, race, sex, and blood collection timing. Conditional logistic regression was used to calculate ORs and 95% confidence intervals (CI).Overall H. pylori prevalence was not associated with colorectal cancer risk (OR, 1.03; 95% CI, 0.59-1.77). However, seropositivity to any of five specific H. pylori proteins (VacA, HP231, HP305, NapA, and HcpC) was associated with a significant 60% to 80% increase in odds of risk. These associations became even stronger when limited to colon cancer risk, particularly for the known H. pylori toxin VacA (OR, 2.24; 95% CI, 1.22-4.11), including a significant, positive dose-response association by VacA antibody levels in quartiles (P < 0.05). Associations with VacA seropositivity were especially strong for early-onset and late-stage cancers.The findings raise the hypothesis that individuals with high levels of antibodies to specific H. pylori proteins may be at higher risk of colon cancer.Further investigation of the H. pylori-colorectal cancer association is warranted to determine the possibility of protein-specific antibody levels as a risk biomarker.

Authors
Epplein, M; Pawlita, M; Michel, A; Peek, RM; Cai, Q; Blot, WJ
MLA Citation
Epplein, M, Pawlita, M, Michel, A, Peek, RM, Cai, Q, and Blot, WJ. "Helicobacter pylori protein-specific antibodies and risk of colorectal cancer." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 22.11 (November 2013): 1964-1974.
PMID
24045925
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
22
Issue
11
Publish Date
2013
Start Page
1964
End Page
1974
DOI
10.1158/1055-9965.epi-13-0702

Intake of specific nonfermented soy foods may be inversely associated with risk of distal gastric cancer in a Chinese population.

Because the association between soy consumption and gastric cancer is inconsistent, we evaluated the putative preventive effect of soy food on gastric cancer risk in the Shanghai Women's and Men's Health Studies, comprising a total of 128,687 participants. Intake of nonfermented soy foods was estimated using 2 validated food-frequency questionnaires. HRs were calculated with 95% CIs for intake amounts of total nonfermented soy food intake, soy protein, and isoflavones as well as individual soy food groups using Cox proportional hazards regression. A total of 493 distal gastric cancer cases were identified by 2010. Although all risk estimates for summary measures of soy food intake above the lowest quartile (quartile 1) were suggestive of a protective effect, no statistically significant associations with risk of distal gastric cancer were found. Among the separate soy food groups, significant reductions in risk of distal gastric cancer by increasing intake of tofu were found in men in quartile 2 (HR: 0.59; 95% CI: 0.40, 0.86), quartile 3 (HR: 0.62; 95% CI: 0.44, 0.88), and quartile 4 (HR: 0.64; 95% CI: 0.42, 0.99), resulting in a significant trend (P-trend = 0.02). Dry bean intake was also inversely associated with decreased risk of gastric cancer, but in postmenopausal women only [quartile 2 (HR: 0.54; 95% CI: 0.30, 0.96); quartile 3 (HR: 0.90; 95% CI: 0.64, 1.27); and quartile 4 (HR: 0.63; 95% CI: 0.43, 0.91)], resulting in a significant trend (P-trend = 0.03). Overall, our study found no statistically significant association between nonfermented soy food intake and distal gastric cancer risk, though the data supported the hypothesis that tofu may protect against distal gastric cancer in men and dry bean consumption may decrease the risk of gastric cancer in postmenopausal women.

Authors
Kweon, S-S; Shu, X-O; Xiang, Y; Cai, H; Yang, G; Ji, B-T; Li, H; Gao, Y-T; Zheng, W; Epplein, M
MLA Citation
Kweon, S-S, Shu, X-O, Xiang, Y, Cai, H, Yang, G, Ji, B-T, Li, H, Gao, Y-T, Zheng, W, and Epplein, M. "Intake of specific nonfermented soy foods may be inversely associated with risk of distal gastric cancer in a Chinese population." The Journal of nutrition 143.11 (November 2013): 1736-1742.
PMID
23986366
Source
epmc
Published In
The Journal of nutrition
Volume
143
Issue
11
Publish Date
2013
Start Page
1736
End Page
1742
DOI
10.3945/jn.113.177675

Prospective study of Helicobacter pylori biomarkers for gastric cancer risk among Chinese men.

Helicobacter pylori is the leading risk factor for gastric cancer, yet only a fraction of infected individuals ever develop neoplasia.To identify potential predictive biomarkers, we assessed the association of 15 antibodies to H. pylori proteins and gastric cancer in a nested case-control study. Blood levels of antibodies were assessed using multiplex serology for 226 incident cases and 451 matched controls from the Shanghai Men's Health Study. ORs and 95% confidence intervals (CI) were calculated using conditional logistic regression.Seropositivity to four (Omp, HP0305, HyuA, and HpaA) proteins was associated with a 1.5- to 3-fold increased risk for gastric cancer. When excluding cases diagnosed within 2 years of study enrollment, seropositivity to two additional proteins (CagA and VacA) showed significant associations with risk. Compared with individuals with three or fewer seropositive results to the six virulent proteins identified in this population, individuals with four to five seropositive results were at a 2-fold increased risk (OR, 2.08; 95% CI, 1.31-3.30) and individuals seropositive to all six proteins had a 3.5-fold increase in risk (OR, 3.49; 95% CI, 2.00-6.11) for gastric cancer. Among individuals diagnosed at least 2 years after study enrollment, these associations were even stronger (ORs, 2.79 and 4.16, respectively).Increasing number of seropositives to six H. pylori proteins may be a risk marker for distal gastric cancer in China.In a population with a 90% prevalence of CagA-positive H. pylori infection, assessment of additional virulent H. pylori proteins might better identify individuals at high risk for gastric cancer.

Authors
Epplein, M; Zheng, W; Xiang, Y-B; Peek, RM; Li, H; Correa, P; Gao, J; Michel, A; Pawlita, M; Cai, Q; Shu, X-O
MLA Citation
Epplein, M, Zheng, W, Xiang, Y-B, Peek, RM, Li, H, Correa, P, Gao, J, Michel, A, Pawlita, M, Cai, Q, and Shu, X-O. "Prospective study of Helicobacter pylori biomarkers for gastric cancer risk among Chinese men." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 21.12 (December 2012): 2185-2192.
PMID
23035179
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
21
Issue
12
Publish Date
2012
Start Page
2185
End Page
2192
DOI
10.1158/1055-9965.epi-12-0792-t

Neighborhood socio-economic characteristics, African ancestry, and Helicobacter pylori sero-prevalence.

The authors recently reported high Helicobacter pylori sero-prevalence among African-Americans of high African ancestry. We sought to determine whether neighborhood-level socio-economic characteristics are associated with H. pylori prevalence and whether this helps explain the link between African ancestry and H. pylori.Antibodies to H. pylori proteins were assessed in the serum of 336 African-American and 329 white Southern Community Cohort Study participants. Prevalence odds ratios (ORs) and 95 % confidence intervals (CIs) for CagA+ and CagA- H. pylori were calculated using polytomous logistic regression in relation to 10 Census block group-level measures of socio-economic status.After adjusting for individual-level characteristics, three neighborhood-level factors were significantly inversely related to CagA+ H. pylori: percent completed high school; median house values; and percent employed (comparing highest to lowest tertile, OR, 0.47, 95 % CI, 0.26-0.85; OR, 0.56, 95 % CI, 0.32-0.99; and OR, 0.59, 95 % CI, 0.34-1.03, respectively). However, accounting for these measures did not attenuate the association between African ancestry and CagA+ H. pylori, with African-Americans of low, medium, and high African ancestry maintaining two-, seven-, and ninefold increased odds, respectively, compared to whites.Neighborhood-level measures of education, employment, and house values are associated with CagA+ H. pylori sero-prevalence, but do not explain the persistent strong relationship between African ancestry level and CagA+ H. pylori. The findings suggest that neighborhood socio-economic status can help to highlight high-risk areas for prevention and screening efforts and that the link between African ancestry and H. pylori may have a biological basis.

Authors
Epplein, M; Cohen, SS; Sonderman, JS; Zheng, W; Williams, SM; Blot, WJ; Signorello, LB
MLA Citation
Epplein, M, Cohen, SS, Sonderman, JS, Zheng, W, Williams, SM, Blot, WJ, and Signorello, LB. "Neighborhood socio-economic characteristics, African ancestry, and Helicobacter pylori sero-prevalence." Cancer causes & control : CCC 23.6 (June 2012): 897-906.
PMID
22527167
Source
epmc
Published In
Cancer Causes & Control
Volume
23
Issue
6
Publish Date
2012
Start Page
897
End Page
906
DOI
10.1007/s10552-012-9960-7

Abstract 1027: Helicobacter pylori blood biomarkers for gastric cancer risk in the Shanghai Men's Health Study

Authors
Epplein, M; Zheng, W; Xiang, Y-B; Peek, RM; Li, H; Correa, P; Gao, J; Michel, A; Pawlita, M; Cai, Q; Shu, X-O
MLA Citation
Epplein, M, Zheng, W, Xiang, Y-B, Peek, RM, Li, H, Correa, P, Gao, J, Michel, A, Pawlita, M, Cai, Q, and Shu, X-O. "Abstract 1027: Helicobacter pylori blood biomarkers for gastric cancer risk in the Shanghai Men's Health Study." April 15, 2012.
Source
crossref
Published In
Cancer Research
Volume
72
Issue
8 Supplement
Publish Date
2012
Start Page
1027
End Page
1027
DOI
10.1158/1538-7445.AM2012-1027

The association of cigarette smoking with gastric cancer: the multiethnic cohort study.

The purpose of this study is to investigate the association of cigarette smoking with gastric cancer.Over 215,000 men and women, representing five ethnic groups (African Americans, Japanese Americans, Latino Americans, Native Hawaiians, and Whites), completed a mailed questionnaire, 1993-1996. After an average follow-up of 7.3 years, 454 men and 242 women were diagnosed with gastric adenocarcinoma. Cox proportional hazard models were used to calculate multivariate-adjusted hazard ratios and 95% confidence intervals.Current cigarette smokers had elevated hazard ratios compared with never smokers among men (HR = 1.98; 95% CI 1.46-2.70) and women (HR = 1.78; 95% CI 1.23-2.57). This positive association was consistent across all five ethnicities. Former smokers had an elevated risk among men, but not among women. There was a significant trend by intensity (cigarettes per day) and duration (years) of smoking among all current smokers. After separation by anatomic location of their tumor, ever smokers had a higher risk for gastric cardia cancer (HR = 2.86; 95% CI 1.66-4.93) than for distal gastric cancer (HR = 1.52; 95% CI 1.25-1.86) among men and women combined. Analysis by histologic tumor type showed a stronger association between current smoking and the intestinal type.Overall, this study shows an association of current cigarette smoking with gastric cancer in both sexes, consistency of this effect across five ethnic groups, evidence for a dose-response effect of smoking in both sexes, a stronger effect for cardia than for distal gastric cancer, and a stronger association for intestinal than for diffuse gastric cancer.

Authors
Nomura, AMY; Wilkens, LR; Henderson, BE; Epplein, M; Kolonel, LN
MLA Citation
Nomura, AMY, Wilkens, LR, Henderson, BE, Epplein, M, and Kolonel, LN. "The association of cigarette smoking with gastric cancer: the multiethnic cohort study." Cancer causes & control : CCC 23.1 (January 2012): 51-58.
PMID
22037905
Source
epmc
Published In
Cancer Causes & Control
Volume
23
Issue
1
Publish Date
2012
Start Page
51
End Page
58
DOI
10.1007/s10552-011-9854-0

Helicobacter pylori prevalence and circulating micronutrient levels in a low-income United States population.

High prevalence of Helicobacter pylori (H. pylori), the leading cause of gastric cancer, and low levels of micronutrients have been observed in many developing countries, and the question remains as to the whether an association between the 2 exists. The present study seeks to further our understanding of this potential connection in the Southern Community Cohort Study, representing a low-income population in the United States. Blood levels of antibodies to H. pylori proteins were assessed by multiplex serology for a sample of 310 African American and white participants, ages 40 to 79 years. Blood collected at baseline was also assayed for levels of carotenoids, tocopherols, retinol, and folate. Multivariate linear regression was used to calculate least-squares mean micronutrient levels within groups defined by H. pylori status. The mean serum levels of all micronutrients assayed were lower among H. pylori + individuals than H. pylori - individuals, significantly for β-carotene, folate, and retinol (decreases of 27.6%, 18.6%, and 9.7%, respectively). Individuals who were seropositive to the virulent CagA+ H. pylori strains had even lower mean levels of micronutrients, particularly β-carotene, folate, total carotenoids, and retinol (decreases of 38.9%, 19.1%, 17.0%, and 11.7%, respectively, compared with H. pylori - individuals). However, dietary micronutrient levels as derived from a food frequency questionnaire did not vary between groups defined by H. pylori status. These results provide support for the hypothesis that H. pylori infection impairs nutrient absorption and suggest a need for future studies to explore the role of H. pylori infection on nutrition and gastric cancer risk in this high-risk population.

Authors
Epplein, M; Signorello, LB; Zheng, W; Cai, Q; Hargreaves, MK; Michel, A; Pawlita, M; Fowke, JH; Correa, P; Blot, WJ
MLA Citation
Epplein, M, Signorello, LB, Zheng, W, Cai, Q, Hargreaves, MK, Michel, A, Pawlita, M, Fowke, JH, Correa, P, and Blot, WJ. "Helicobacter pylori prevalence and circulating micronutrient levels in a low-income United States population." Cancer prevention research (Philadelphia, Pa.) 4.6 (June 2011): 871-878.
PMID
21436385
Source
epmc
Published In
Cancer Prevention Research
Volume
4
Issue
6
Publish Date
2011
Start Page
871
End Page
878
DOI
10.1158/1940-6207.capr-10-0398

Race, African ancestry, and Helicobacter pylori infection in a low-income United States population.

Gastric cancer incidence in African Americans is twice that of whites, and differing prevalence of Helicobacter pylori strain-specific isolates may help explain the disparity.Serum levels of antibodies to each of 15 H. pylori proteins were assessed using multiplex serology for a sample of 689 African American and white participants from the Southern Community Cohort Study. African and European admixture was estimated using a panel of 276 ancestry genetic markers, with "low," "medium," and "high" categories of African ancestry defined as <85%, 85% to 95%, and ≥95%.The majority (79%) of our study population were sero-positive for H. pylori. African American race was associated with a two- to sixfold increased odds for sero-positivity to eight H. pylori proteins, including the cancer-associated virulence constituents CagA [odds ratio (OR), 6.4; 95% CI, 4.5-9.1], and VacA (OR, 2.3; 95% CI, 1.5-3.5). Compared to whites, African Americans of low, medium, and high African ancestry had 1.6-, 4.1-, and 5.2-fold increased odds of sero-positivity to H. pylori, primarily related to CagA sero-positive strains, for which increasing African ancestry led to 2.5-, 9.6-, and 13.1-fold increased odds. Among African Americans alone, compared to those of low African ancestry, African Americans of medium and high African ancestry had 2.5- and 3.4-fold increased odds of sero-positivity to H. pylori, and 3.5- and 4.9-fold increased odds of CagA sero-positive H. pylori strains.Host genetic variation and/or lifestyle factors associated with African ancestry contribute to the likelihood of infection with H. pylori, particularly its virulent strains, in this low-income U.S. southern population.Our findings that low-income African Americans of high African ancestry have a particularly high prevalence of antibodies against H. pylori provides a framework for further research into better detection and prevention of gastric cancer in this population.

Authors
Epplein, M; Signorello, LB; Zheng, W; Peek, RM; Michel, A; Williams, SM; Pawlita, M; Correa, P; Cai, Q; Blot, WJ
MLA Citation
Epplein, M, Signorello, LB, Zheng, W, Peek, RM, Michel, A, Williams, SM, Pawlita, M, Correa, P, Cai, Q, and Blot, WJ. "Race, African ancestry, and Helicobacter pylori infection in a low-income United States population." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 20.5 (May 2011): 826-834.
PMID
21357376
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
20
Issue
5
Publish Date
2011
Start Page
826
End Page
834
DOI
10.1158/1055-9965.epi-10-1258

Quality of life after breast cancer diagnosis and survival.

To examine the association of quality of life (QOL) after diagnosis of breast cancer with mortality and recurrence.From 2002 to 2004, a total of 2,230 breast cancer survivors completed the General Quality of Life Inventory-74 6 months after diagnosis as part of the Shanghai Breast Cancer Survivor Study. Also collected at baseline was information on demographic and clinical characteristics. At 36 months postdiagnosis, 1,845 of these women were re-evaluated for QOL. Outcomes were ascertained by in-person interview and record linkage to the vital statistics registry. The association of QOL with total mortality and cancer recurrence was assessed by using Cox regression analysis.During a median follow-up of 4.8 years after the 6-month postdiagnosis QOL assessment, 284 deaths were identified. Recurrence was documented in 267 patients after 108 patients with stage IV breast cancer or recurrence before study enrollment were excluded. Women with the highest tertile of social well-being QOL score, compared with those with the lowest score, had a 38% decreased risk of mortality (95% CI, 0.46 to 0.85; P for trend = .002) and a 48% decreased risk of breast cancer recurrence (95% CI, 0.38 to 0.71; P for trend < .001). QOL assessed at 36 months postdiagnosis was not significantly associated with subsequent risk of mortality or recurrence.Social well-being in the first year after cancer diagnosis is a significant prognostic factor for breast cancer recurrence or mortality, suggesting a possible avenue of intervention by maintaining or enhancing social support for women soon after their breast cancer diagnosis to improve disease outcomes.

Authors
Epplein, M; Zheng, Y; Zheng, W; Chen, Z; Gu, K; Penson, D; Lu, W; Shu, X-O
MLA Citation
Epplein, M, Zheng, Y, Zheng, W, Chen, Z, Gu, K, Penson, D, Lu, W, and Shu, X-O. "Quality of life after breast cancer diagnosis and survival." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.4 (February 2011): 406-412.
PMID
21172892
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
4
Publish Date
2011
Start Page
406
End Page
412
DOI
10.1200/jco.2010.30.6951

Gastric cancer: an infectious disease.

The role of infectious agents and chronic inflammation in carcinogenesis is being increasingly recognized. It has been estimated that about 18% of cancers are directly linked to infections, particularly gastric adenocarcinoma (Helicobacter pylori), cervical carcinoma (human papilloma viruses), and hepatocarcinoma (hepatitis B and C viruses). Multiple clinical trials of COX-2 inhibitors and other antiinflammatory agents have shown a beneficial effect on the development of diverse tumors, such as those of the colon, stomach, prostate, and breast. However, their mechanism of action is not completely understood and may differ among the infectious agents and tumor types. Because gastric adenocarcinomas account for more than 90% of all gastric malignancies, this review focuses on adenocarcinomas.

Authors
Piazuelo, MB; Epplein, M; Correa, P
MLA Citation
Piazuelo, MB, Epplein, M, and Correa, P. "Gastric cancer: an infectious disease." Infectious disease clinics of North America 24.4 (December 2010): 853-vii. (Review)
PMID
20937454
Source
epmc
Published In
Infectious Disease Clinics of North America
Volume
24
Issue
4
Publish Date
2010
Start Page
853
End Page
vii
DOI
10.1016/j.idc.2010.07.010

Complex hyperplasia with and without atypia: clinical outcomes and implications of progestin therapy.

Limited data exist to inform clinicians and patients as to the likelihood of long-term endometrial hyperplasia response to progestin therapy, especially for atypical hyperplasia. We evaluated women with complex and atypical endometrial hyperplasia, comparing those prescribed progestin with those not prescribed progestin.This retrospective cohort study was conducted in 1985-2005 among women aged 18-88 years at an integrated health plan in Washington State. Women were ineligible if they achieved an outcome (endometrial carcinoma, hysterectomy, or both) within 8 weeks of hyperplasia diagnosis. Exposure was progestin use for at least 14 days by duration and recency. Outcomes included rate of 1) endometrial carcinoma, 2) hysterectomy, or 3) both. Analyses performed included Kaplan-Meier, incident rate ratios, and Cox proportional hazard ratios.One thousand four hundred forty-three eligible women were identified. One thousand two hundred one had complex (n=164 no progestin) and 242 had atypical (n=62 no progestin) hyperplasia. During follow-up, a median of 5.3 years (range 8 weeks to 20.8 years), 71 women were diagnosed with endometrial carcinoma (35 complex, 36 atypia) and 323 underwent hysterectomy (216 complex, 107 atypia). Among women with complex and atypical hyperplasia, rates of endometrial carcinoma among progestin users were 3.6 and 20.5 per 1,000 woman-years, respectively (compared with women who did not use progestin, 10.8 and 101.4). Among women with complex and atypical hyperplasia, rates of hysterectomy among progestin users were 23.3 and 61.4 per 1,000 woman-years, respectively (compared with women who did not use progestin, 55.1 and 297.3).Endometrial carcinoma risk is diminished approximately threefold to fivefold in women diagnosed with complex or atypical endometrial hyperplasia and dispensed progestin; hysterectomy risk is also decreased.II.

Authors
Reed, SD; Newton, KM; Garcia, RL; Allison, KH; Voigt, LF; Jordan, CD; Epplein, M; Swisher, E; Upson, K; Ehrlich, KJ; Weiss, NS
MLA Citation
Reed, SD, Newton, KM, Garcia, RL, Allison, KH, Voigt, LF, Jordan, CD, Epplein, M, Swisher, E, Upson, K, Ehrlich, KJ, and Weiss, NS. "Complex hyperplasia with and without atypia: clinical outcomes and implications of progestin therapy." Obstetrics and gynecology 116.2 Pt 1 (August 2010): 365-373.
PMID
20664397
Source
epmc
Published In
Obstetrics & Gynecology (Elsevier)
Volume
116
Issue
2 Pt 1
Publish Date
2010
Start Page
365
End Page
373
DOI
10.1097/aog.0b013e3181e93330

Fruit and vegetable consumption and risk of distal gastric cancer in the Shanghai Women's and Men's Health studies.

Results from case-control and cohort studies of the association between fruit and vegetable consumption and gastric cancer risk have been inconsistent. Cases for the current study consisted of incident distal gastric cancers identified between 1996 and 2007 among members of the Shanghai Women's Health Study (n = 206) and the Shanghai Men's Health Study (n = 132). Intakes of fruits, vegetables, and select micronutrients were assessed on the basis of validated food frequency questionnaires. Multivariate-adjusted hazards ratios and 95% confidence intervals were calculated by Cox proportional hazards regression. For women, no associations were found between gastric cancer risk and the highest intake of fruits (hazard ratio (HR) = 1.02, 95% confidence interval (CI): 0.68, 1.54; P(trend) = 0.87) or vegetables (HR = 0.89, 95% CI: 0.60, 1.31; P(trend) = 0.32). For men, increased fruit intake was associated with decreased risk of distal gastric cancer (for the highest quartile of intake, HR = 0.50, 95% CI: 0.29, 0.84; P(trend) = 0.004), but no association was seen with increased intake of vegetables (HR = 1.00, 95% CI: 0.59, 1.68; P(trend) = 0.87). The inverse association with fruit intake for men was more evident among ever smokers (P(trend) = 0.001) than never smokers (P(trend) = 0.67). No associations between dietary intakes of select antioxidant micronutrients were seen for men or women. Fruit intake is inversely associated with distal gastric cancer risk among men in Shanghai, China.

Authors
Epplein, M; Shu, X-O; Xiang, Y-B; Chow, W-H; Yang, G; Li, H-L; Ji, B-T; Cai, H; Gao, Y-T; Zheng, W
MLA Citation
Epplein, M, Shu, X-O, Xiang, Y-B, Chow, W-H, Yang, G, Li, H-L, Ji, B-T, Cai, H, Gao, Y-T, and Zheng, W. "Fruit and vegetable consumption and risk of distal gastric cancer in the Shanghai Women's and Men's Health studies." American journal of epidemiology 172.4 (August 2010): 397-406.
PMID
20647333
Source
epmc
Published In
American Journal of Epidemiology
Volume
172
Issue
4
Publish Date
2010
Start Page
397
End Page
406
DOI
10.1093/aje/kwq144

Association of maternal and intrauterine characteristics with age at menarche in a multiethnic population in Hawaii.

This study seeks to further elucidate the mother-daughter hormonal relationship and its effects on daughter's breast cancer risk through the association with early age at menarche. Four hundred and thirty-eight healthy girls, age 9-18 and of White, Asian, and/or Polynesian race/ethnicity, were recruited from an HMO on Oahu, Hawaii. Anthropometric measures were taken at a clinic visit, and family background questionnaires were completed. Cox proportional hazards regression was used to test the association of maternal and intrauterine hormone-related exposures with age at menarche. Weight and gestational age at birth and maternal pregnancy-induced nausea were not associated with age at menarche. Each year older of the mother's age at menarche was associated with a 21% reduced risk of an early age at menarche for the daughter (95% CI: 0.73-0.86). This association between mother's and daughter's menarcheal age was statistically significant for girls of Asian, White, and Mixed, Asian/White race/ethnicity, but not for girls of Mixed, part-Polynesian race/ethnicity (p (interaction) = 0.01). There was a suggestion that maternal history of breast cancer was associated with an increased risk of early age at menarche (HR = 2.18, 95% CI: 0.95-4.98); there was no association with second-degree family history. These findings support the hypothesis that maternal and intrauterine hormone-related exposures are associated with age at menarche.

Authors
Epplein, M; Novotny, R; Daida, Y; Vijayadeva, V; Onaka, AT; Le Marchand, L
MLA Citation
Epplein, M, Novotny, R, Daida, Y, Vijayadeva, V, Onaka, AT, and Le Marchand, L. "Association of maternal and intrauterine characteristics with age at menarche in a multiethnic population in Hawaii." Cancer causes & control : CCC 21.2 (February 2010): 259-268.
PMID
19862633
Source
epmc
Published In
Cancer Causes & Control
Volume
21
Issue
2
Publish Date
2010
Start Page
259
End Page
268
DOI
10.1007/s10552-009-9457-1

Nonsteroidal antiinflammatory drugs and risk of gastric adenocarcinoma: the multiethnic cohort study.

In many epidemiologic studies, investigators have reported an inverse relation between nonsteroidal antiinflammatory drugs (NSAIDs) and colon cancer, but fewer researchers have examined the relation with gastric cancer. Cases for this study consisted of incident gastric adenocarcinomas (n = 643) identified between 1993 and 2004 among members of the Multiethnic Cohort (Hawaii and Los Angeles, California). Aspirin and nonaspirin NSAID use was assessed on the basis of a self-administered questionnaire. Multivariate-adjusted hazards ratios and 95% confidence intervals were calculated using Cox proportional hazards regression. Compared with no regular use, regular use of aspirin was associated with a decreased risk of distal gastric cancer (hazard ratio (HR) = 0.73, 95% confidence interval (CI): 0.61, 0.89; P(trend) = 0.009), but use of nonaspirin NSAIDs was not (HR = 1.00, 95% CI: 0.81, 1.24; P(trend) = 0.99). The inverse association with regular aspirin use was observed only for intestinal-type distal gastric adenocarcinoma (HR = 0.66, 95% CI: 0.47, 0.95; P(trend) = 0.01), as opposed to diffuse-type distal gastric adenocarcinoma (HR = 0.92, 95% CI: 0.53, 1.60; P(trend) = 0.45). In this study, the authors found aspirin use to be inversely associated with distal gastric adenocarcinoma, particularly of the intestinal type.

Authors
Epplein, M; Nomura, AMY; Wilkens, LR; Henderson, BE; Kolonel, LN
MLA Citation
Epplein, M, Nomura, AMY, Wilkens, LR, Henderson, BE, and Kolonel, LN. "Nonsteroidal antiinflammatory drugs and risk of gastric adenocarcinoma: the multiethnic cohort study." American journal of epidemiology 170.4 (August 2009): 507-514.
PMID
19584132
Source
epmc
Published In
American Journal of Epidemiology
Volume
170
Issue
4
Publish Date
2009
Start Page
507
End Page
514
DOI
10.1093/aje/kwp162

Association of plasma micronutrient levels and urinary isoprostane with risk of lung cancer: the multiethnic cohort study.

Although smoking is the primary risk factor for lung cancer, there is evidence to suggest that fruit and vegetable intake are important cofactors. The present case-control study, nested within the Multiethnic Cohort Study, examined the associations of biomarkers of fruit and vegetable intake (individual plasma micronutrient levels), serum selenium, and a urinary biomarker for total lipid peroxidation with lung cancer risk. Two hundred seven incident cases were matched to 414 controls on age, sex, ethnicity, study location (Hawaii or California), smoking status, date/time of collection, and hours of fasting. We measured prediagnositic circulating levels of individual tocopherols and carotenoids, retinol, and serum selenium, and urinary 15-isoprostane F(2t). Conditional logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CI). For men, strong reductions in risk were seen with increasing tertiles of each plasma carotenoid, with the ORs for the third tertile, compared with the first tertile, ranging from 0.24 to 0.45 (P(trends), 0.002-0.04). No associations were found among women for carotenoids or among either sex for tocopherols, selenium, and retinol. A doubling in risk was seen for men in the second and third tertiles, compared with the first tertile of urinary 15-isoprostane F(2t) (OR, 2.31; 95% CI, 1.02-5.25; and OR, 2.16; 95% CI, 0.98-4.78). This study supports the previously observed association between circulating carotenoids and lung cancer risk in men, and adds to the limited literature regarding urinary 15-isoprostane F(2t) as a marker of cancer risk. Future research examining the possible relationship between isoprostanes and lung cancer is warranted.

Authors
Epplein, M; Franke, AA; Cooney, RV; Morris, JS; Wilkens, LR; Goodman, MT; Murphy, SP; Henderson, BE; Kolonel, LN; Le Marchand, L
MLA Citation
Epplein, M, Franke, AA, Cooney, RV, Morris, JS, Wilkens, LR, Goodman, MT, Murphy, SP, Henderson, BE, Kolonel, LN, and Le Marchand, L. "Association of plasma micronutrient levels and urinary isoprostane with risk of lung cancer: the multiethnic cohort study." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 18.7 (July 2009): 1962-1970.
PMID
19531680
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
18
Issue
7
Publish Date
2009
Start Page
1962
End Page
1970
DOI
10.1158/1055-9965.epi-09-0003

Incidence of endometrial hyperplasia.

The objective of the study was to estimate the age-specific incidence of endometrial hyperplasia: simple, complex, and atypical, in order of increasing likelihood of progression to carcinoma.Women aged 18-90 years with endometrial pathology specimens (1985-2003) at a large integrated health plan were identified using automated data. Incidence rates were obtained by dividing the number of cases by the estimated number of female health plan enrollees who retained a uterus.Endometrial hyperplasia peak incidence was: simple, 142 per 100,000 woman-years, complex, 213 per 100,000 woman-years, both in the early 50s; and atypical, 56 per 100,000 woman-years in the early 60s. Age-adjusted incidence decreased over the study period, especially for atypical hyperplasia.Endometrial hyperplasia incidence without and with atypia peaks in the early postmenopausal years and in the early 60s, respectively. Given that some cases of endometrial hyperplasia likely go undiagnosed, the figures provided should be viewed as minimum estimates of the true incidence.

Authors
Reed, SD; Newton, KM; Clinton, WL; Epplein, M; Garcia, R; Allison, K; Voigt, LF; Weiss, NS
MLA Citation
Reed, SD, Newton, KM, Clinton, WL, Epplein, M, Garcia, R, Allison, K, Voigt, LF, and Weiss, NS. "Incidence of endometrial hyperplasia." American journal of obstetrics and gynecology 200.6 (June 2009): 678.e1-678.e6.
PMID
19393600
Source
epmc
Published In
American Journal of Obstetrics & Gynecology
Volume
200
Issue
6
Publish Date
2009
Start Page
678.e1
End Page
678.e6
DOI
10.1016/j.ajog.2009.02.032

Progestin Therapy of Complex Endometrial Hyperplasia With and Without Atypia

Authors
Reed, SD; Voigt, LF; Newton, KM; Garcia, RH; Allison, KH; Epplein, M; Jordan, D; Swisher, E; Weiss, NS
MLA Citation
Reed, SD, Voigt, LF, Newton, KM, Garcia, RH, Allison, KH, Epplein, M, Jordan, D, Swisher, E, and Weiss, NS. "Progestin Therapy of Complex Endometrial Hyperplasia With and Without Atypia." Obstetrical & Gynecological Survey 64.6 (June 2009): 382-383.
Source
crossref
Published In
Obstetrical and Gynecological Survey
Volume
64
Issue
6
Publish Date
2009
Start Page
382
End Page
383
DOI
10.1097/01.ogx.0000349785.20763.6d

Complex hyperplasia with and without atypia - clinical outcomes and implications of progestin therapy in a 20 year cohort study of 1510 women

Authors
Reed, S; Newton, K; Garcia, R; Allison, K; Voigt, L; Epplein, M; Swisher, E; Weiss, N
MLA Citation
Reed, S, Newton, K, Garcia, R, Allison, K, Voigt, L, Epplein, M, Swisher, E, and Weiss, N. "Complex hyperplasia with and without atypia - clinical outcomes and implications of progestin therapy in a 20 year cohort study of 1510 women." May 1, 2009.
Source
wos-lite
Published In
Cancer Research
Volume
69
Publish Date
2009

Progestin therapy of complex endometrial hyperplasia with and without atypia.

To assess the likelihood of histologic persistence/progression of complex hyperplasia and atypical hyperplasia among women treated with progestin compared with those not treated, with attention to type, dose, and duration.This was a cohort study at an integrated health plan of women, ages 18-85 years, with complex or atypical hyperplasia on independent pathology review with a second endometrial specimen in the 2-6 months after the index diagnosis. Progestin therapy between index diagnosis and follow-up biopsy was determined from the pharmacy database. Medical record abstraction was performed. Relative risks (RRs), adjusted for age and body mass index, were calculated.Among 185 women, average age 55.9 years, follow-up 16.1 weeks, 115 had complex and 70 had atypical hyperplasia. Among women with complex hyperplasia, 28.4% of those treated with progestin and 30.0% of those not treated had persistence/progression (RR 1.20, 95% confidence interval [CI] 0.53-2.72). Among women with atypical hyperplasia, 26.9% of those treated with progestin and 66.7% of those not treated had persistence/progression (RR 0.39, 95% CI 0.21-0.70); there was a suggestion that use of at least a medium dose, or a duration of at least 3 months, was associated with a particularly low probability of persistence/progression.Although progestin treatment of women with atypical hyperplasia was associated with a substantial increase in the likelihood of regression of the lesion during the ensuing 2-6 months, persistence/progression was nonetheless present in more than one quarter of treated women. Regression of complex hyperplasia without atypia was common whether progestin had or had not been used.

Authors
Reed, SD; Voigt, LF; Newton, KM; Garcia, RH; Allison, HK; Epplein, M; Jordan, D; Swisher, E; Weiss, NS
MLA Citation
Reed, SD, Voigt, LF, Newton, KM, Garcia, RH, Allison, HK, Epplein, M, Jordan, D, Swisher, E, and Weiss, NS. "Progestin therapy of complex endometrial hyperplasia with and without atypia." Obstetrics and gynecology 113.3 (March 2009): 655-662.
PMID
19300331
Source
epmc
Published In
Obstetrics & Gynecology (Elsevier)
Volume
113
Issue
3
Publish Date
2009
Start Page
655
End Page
662
DOI
10.1097/aog.0b013e318198a10a

Plasma carotenoids, retinol, and tocopherols and postmenopausal breast cancer risk in the Multiethnic Cohort Study: a nested case-control study.

Assessments by the handful of prospective studies of the association of serum antioxidants and breast cancer risk have yielded inconsistent results. This multiethnic nested case-control study sought to examine the association of plasma carotenoids, retinol, and tocopherols with postmenopausal breast cancer risk.From the biospecimen subcohort of the Multiethnic Cohort Study, 286 incident postmenopausal breast cancer cases were matched to 535 controls on age, sex, ethnicity, study location (Hawaii or California), smoking status, date/time of collection and hours of fasting. We measured prediagnostic circulating levels of individual carotenoids, retinol, and tocopherols. Conditional logistic regression was used to compute odds ratios and 95% confidence intervals.Women with breast cancer tended to have lower levels of plasma carotenoids and tocopherols than matched controls, but the differences were not large or statistically significant and the trends were not monotonic. No association was seen with retinol. A sensitivity analysis excluding cases diagnosed within 1 year after blood draw did not alter the findings.The lack of significant associations in this multiethnic population is consistent with previously observed results from less racially-diverse cohorts and serves as further evidence against a causal link between plasma micronutrient concentrations and postmenopausal breast cancer risk.

Authors
Epplein, M; Shvetsov, YB; Wilkens, LR; Franke, AA; Cooney, RV; Le Marchand, L; Henderson, BE; Kolonel, LN; Goodman, MT
MLA Citation
Epplein, M, Shvetsov, YB, Wilkens, LR, Franke, AA, Cooney, RV, Le Marchand, L, Henderson, BE, Kolonel, LN, and Goodman, MT. "Plasma carotenoids, retinol, and tocopherols and postmenopausal breast cancer risk in the Multiethnic Cohort Study: a nested case-control study." Breast cancer research : BCR 11.4 (January 2009): R49-.
PMID
19619335
Source
epmc
Published In
Breast Cancer Research
Volume
11
Issue
4
Publish Date
2009
Start Page
R49
DOI
10.1186/bcr2338

Urinary isothiocyanates; glutathione S-transferase M1, T1, and P1 polymorphisms; and risk of colorectal cancer: the Multiethnic Cohort Study.

Although an association between diet, especially cruciferous vegetables, and colorectal cancer has been hypothesized, recent studies have been inconsistent with their findings. One possibility for the discrepant results is that the interaction with related genes has not generally been considered. The present study examined the associations among urinary isothiocyanates, glutathione S-transferase (GST) polymorphisms, and colorectal cancer risk in a case-control study nested within the Multiethnic Cohort Study, based in Hawaii and Los Angeles, California. We measured prediagnositic urinary isothiocyanate levels adjusted for creatinine and analyzed GSTM1, GSTT1, and GSTP1 polymorphisms in 173 cases and 313 matched controls, with biospecimens collected between 2001 and 2006. Conditional logistic regression was used to compute odds ratios and 95% confidence intervals (95% CI). A detectable amount of urinary isothiocyanates was associated with a 41% decrease in colorectal cancer risk (95% CI, 0.36-0.98). No significant, main-effect associations were seen with a homozygous deletion of the GSTM1 or GSTT1 polymorphism, or with the AG or GG genotypes for GSTP1 rs1695. There was a weak suggestion that for individuals with the GSTP1 AG or GG genotype, a detectable amount of isothiocyanates further decreases one's risk of colorectal cancer compared with those with the GSTP1 AA genotype, but the interaction term was not statistically significant (P = 0.09). This is only the second study published on the association between urinary isothiocyanates and colorectal cancer risk. The results suggest that further studies, with larger numbers, examining a possible interaction with the GSTP1 polymorphisms are warranted.

Authors
Epplein, M; Wilkens, LR; Tiirikainen, M; Dyba, M; Chung, F-L; Goodman, MT; Murphy, SP; Henderson, BE; Kolonel, LN; Le Marchand, L
MLA Citation
Epplein, M, Wilkens, LR, Tiirikainen, M, Dyba, M, Chung, F-L, Goodman, MT, Murphy, SP, Henderson, BE, Kolonel, LN, and Le Marchand, L. "Urinary isothiocyanates; glutathione S-transferase M1, T1, and P1 polymorphisms; and risk of colorectal cancer: the Multiethnic Cohort Study." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 18.1 (January 2009): 314-320.
PMID
19124514
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
18
Issue
1
Publish Date
2009
Start Page
314
End Page
320
DOI
10.1158/1055-9965.epi-08-0627

Endometrial hyperplasia risk in relation to recent use of oral contraceptives and hormone therapy.

We sought to examine the relationship between recent use of oral contraceptives and hormone therapy and endometrial hyperplasia (EH) risk.Cases comprised women diagnosed with complex EH (n = 289) or atypical EH (n = 173) between 1985 and 2003. One age-matched control was selected for each case; excluded were women with a prior hysterectomy or diagnosis of EH or endometrial cancer. Hormone use in the 6 months prior to the date of the case's first symptoms was ascertained using a pharmacy database and medical records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.Three (1.1%) cases had used oral contraceptives, compared to 16 (6.0%) controls (OR = 0.2, 95% CI: 0.0-0.6). Fifty-one (16.8%) cases had taken estrogen-only hormone therapy, in contrast to two (0.7%) controls (OR = 37.6, 95% CI: 8.8-160.0). The risk of EH among estrogen plus progestin hormone users did not differ from that of non-users (OR = 0.7, 95% CI: 0.4-1.1).This study suggests that previous findings of the association of estrogen-only hormone therapy with increased risk of EH and the lack of an association between estrogen plus progestin hormone therapy and EH risk are likely to apply to both complex EH and atypical EH. Further examination of the association between oral contraceptives and EH, with greater numbers of OC users, is warranted.

Authors
Epplein, M; Reed, SD; Voigt, LF; Newton, KM; Holt, VL; Weiss, NS
MLA Citation
Epplein, M, Reed, SD, Voigt, LF, Newton, KM, Holt, VL, and Weiss, NS. "Endometrial hyperplasia risk in relation to recent use of oral contraceptives and hormone therapy." Annals of epidemiology 19.1 (January 2009): 1-7.
PMID
19064186
Source
epmc
Published In
Annals of Epidemiology
Volume
19
Issue
1
Publish Date
2009
Start Page
1
End Page
7
DOI
10.1016/j.annepidem.2008.08.099

Association of Helicobacter pylori infection and diet on the risk of gastric cancer: a case-control study in Hawaii.

The risk factors most strongly associated with gastric cancer are the gastric bacteria Helicobacter pylori and diet. Utilizing data from a case-control study among residents in Hawaii, we examined the association of diet, presence of H. pylori, and non-cardia gastric cancer risk.Serum taken at diagnosis for cases (n = 212) and at interview for controls (n = 336) was assayed for IgG antibodies to H. pylori group antigens and to a recombinant fragment of the cytotoxin-associated antigen A (CagA) protein, and subjects completed food frequency questionnaires. Risk measures were calculated using logistic regression. The likelihood ratio test was used to assess interactions.Inverse associations were found between gastric cancer risk and increasing intake of several micronutrients and vegetables among all individuals. For H. pylori/CagA-positive subjects, significant trends were present for total, green, and yellow vegetables, while a significant trend was present only for yellow vegetables among H. pylori/CagA-negative individuals. For intestinal gastric cancer, there was a suggestion that intake of vegetables, especially cruciferous vegetables, had a stronger protective effect for the H. pylori/CagA-positive group.Diet may play a greater role in the etiology of non-cardia gastric cancer among individuals with evidence of H. pylori infection than among those without.

Authors
Epplein, M; Nomura, AMY; Hankin, JH; Blaser, MJ; Perez-Perez, G; Stemmermann, GN; Wilkens, LR; Kolonel, LN
MLA Citation
Epplein, M, Nomura, AMY, Hankin, JH, Blaser, MJ, Perez-Perez, G, Stemmermann, GN, Wilkens, LR, and Kolonel, LN. "Association of Helicobacter pylori infection and diet on the risk of gastric cancer: a case-control study in Hawaii." Cancer causes & control : CCC 19.8 (October 2008): 869-877.
PMID
18369531
Source
epmc
Published In
Cancer Causes & Control
Volume
19
Issue
8
Publish Date
2008
Start Page
869
End Page
877
DOI
10.1007/s10552-008-9149-2

Risk of complex and atypical endometrial hyperplasia in relation to anthropometric measures and reproductive history.

The authors sought to test the hypothesis that characteristics and exposures which influence the balance of estrogen and progesterone bear on the incidence of endometrial hyperplasia (EH), a noninvasive proliferation of the lining of the uterus. Cases included all female members of Group Health (Washington State) who were diagnosed with complex EH or EH with atypia during the period 1985-2003 and whose diagnoses were confirmed in a pathology review (n = 446). Controls were selected randomly from Group Health membership files and were matched to the cases by age and enrollment status at the reference date. An increased risk of EH was associated with increasing body mass index and nulliparity. There was a suggestion of a decreased risk of EH with atypia among current smokers. No association with diabetes or hypertension was found. The risk factors observed to be associated with EH in this study are similar to those associated with endometrial cancer. Whether these risk factors predispose women to cancer simply by increasing EH incidence or continue to augment cancer risk even after EH is present is currently unknown.

Authors
Epplein, M; Reed, SD; Voigt, LF; Newton, KM; Holt, VL; Weiss, NS
MLA Citation
Epplein, M, Reed, SD, Voigt, LF, Newton, KM, Holt, VL, and Weiss, NS. "Risk of complex and atypical endometrial hyperplasia in relation to anthropometric measures and reproductive history." American journal of epidemiology 168.6 (September 2008): 563-570.
PMID
18682485
Source
epmc
Published In
American Journal of Epidemiology
Volume
168
Issue
6
Publish Date
2008
Start Page
563
End Page
570
DOI
10.1093/aje/kwn168

Epplein et al. Respond to "Endometrial Hyperplasia--Getting Back to Normal"

Authors
Epplein, M; Reed, SD; Voigt, LF; Newton, KM; Holt, VL; Weiss, NS
MLA Citation
Epplein, M, Reed, SD, Voigt, LF, Newton, KM, Holt, VL, and Weiss, NS. "Epplein et al. Respond to "Endometrial Hyperplasia--Getting Back to Normal"." American Journal of Epidemiology 168.6 (July 15, 2008): 575-576.
Source
crossref
Published In
American Journal of Epidemiology
Volume
168
Issue
6
Publish Date
2008
Start Page
575
End Page
576
DOI
10.1093/aje/kwn167

Trends in the incidence rates of nasopharyngeal carcinoma among Chinese Americans living in Los Angeles County and the San Francisco metropolitan area, 1992-2002.

Nasopharyngeal carcinoma is much more common in Asian countries than in Western countries. However, since the 1980s, nasopharyngeal carcinoma incidence has fallen among both men and women in Hong Kong, and recently a similar trend has also been noted in Singapore. Using data from the Surveillance, Epidemiology, and End Results Program and the US Census, the authors evaluated recent trends in the incidence rates of nasopharyngeal carcinoma among Chinese living in Los Angeles County and in the San Francisco-Oakland (California) metropolitan area. From 1992 to 2002, the rates of nasopharyngeal carcinoma in these two populations decreased in men by 37% (95% confidence interval: -54, -12) but in women by just 1% (95% confidence interval: -40, 64). In Chinese men, the overall decline in incidence was limited primarily to a decline in the rate of type I tumors (differentiated squamous tumors with keratin production). While the reasons underlying the observed patterns of incidence remain to be determined, changes in lifestyle and environment are likely to be contributory factors.

Authors
Sun, L-M; Epplein, M; Li, CI; Vaughan, TL; Weiss, NS
MLA Citation
Sun, L-M, Epplein, M, Li, CI, Vaughan, TL, and Weiss, NS. "Trends in the incidence rates of nasopharyngeal carcinoma among Chinese Americans living in Los Angeles County and the San Francisco metropolitan area, 1992-2002." American journal of epidemiology 162.12 (December 2005): 1174-1178.
PMID
16282240
Source
epmc
Published In
American Journal of Epidemiology
Volume
162
Issue
12
Publish Date
2005
Start Page
1174
End Page
1178
DOI
10.1093/aje/kwi345

Smoking-adjusted lung cancer incidence among Asian-Americans (United States).

OBJECTIVE: Chinese women residing in Asia and Hawaii have low consumption of tobacco but a high incidence of lung cancer. To explore this question further, we conducted a study of lung cancer among Chinese women residing in mainland US. METHODS: Using data from NCI's SEER program, we identified residents of Los Angeles County, the San Francisco Metropolitan Area, and the Seattle-Puget Sound Area who were 50 years or older, diagnosed with cancer of the lung or bronchus in 1999-2001, with race specified as non-Hispanic white (n = 18,493), Chinese (n = 853), Filipino (n = 615), or Japanese (n = 282). The sex-specific observed number of lung cancer cases among each Asian sub-group was compared to the expected number of lung cancer cases for each Asian sub-group. The expected number was determined by multiplying the age-, sex-, and geographic area-adjusted incidence rates for non-Hispanic whites by the age- and sex-specific ratio of percentage of current smokers in each Asian sub-group to whites in 1990, and then by the size of the respective Asian populations. RESULTS: Chinese women had a four-fold increased risk of lung cancer, and Filipino women a two-fold increased risk, compared to that expected based on rates in US non-Hispanic whites with a similar proportion of cigarette smokers. Lung cancer among Chinese, Filipino, and Japanese males, as well as Japanese females, did not deviate from expected risk. Among Chinese women, the increased risk was largely restricted to adenocarcinoma and large cell undifferentiated carcinoma. CONCLUSIONS: Chinese female residents of the western US mainland have a much higher risk of lung cancer than would be predicted from their tobacco use patterns, just as they do in Asia.

Authors
Epplein, M; Schwartz, SM; Potter, JD; Weiss, NS
MLA Citation
Epplein, M, Schwartz, SM, Potter, JD, and Weiss, NS. "Smoking-adjusted lung cancer incidence among Asian-Americans (United States)." Cancer causes & control : CCC 16.9 (November 2005): 1085-1090.
PMID
16184474
Source
epmc
Published In
Cancer Causes & Control
Volume
16
Issue
9
Publish Date
2005
Start Page
1085
End Page
1090
DOI
10.1007/s10552-005-0330-6

A sister's risk: family history as a predictor of preeclampsia.

OBJECTIVE: The purpose of this study was to determine if women with preeclampsia are more likely to have a sister who also had preeclampsia. STUDY DESIGN: This was a population-based case-control study using data from Washington (WA) state birth certificates linked to hospital discharge records. Cases were women with gestational hypertension (n = 1611) or preeclampsia (n = 1071); controls (n = 8041) had normotensive pregnancies. All women delivered their first child between 1987 to 2002 and had a sister with a previous delivery in WA. RESULTS: Women with preeclampsia were 2.3 times (95%CI 1.8-2.9) more likely to have a sister who had preeclampsia; those with gestational hypertension were 1.6 times (95%CI 1.3-2.0) more likely to have a sister with gestational hypertension. Similar results were obtained following stratification by age, race, smoking status, or body mass index. CONCLUSION: The greater likelihood of preeclampsia among sisters of women with a previous preeclamptic pregnancy is consistent with a pathophysiologic role for genetic and/or behavioral factors that cluster in families.

Authors
Carr, DB; Epplein, M; Johnson, CO; Easterling, TR; Critchlow, CW
MLA Citation
Carr, DB, Epplein, M, Johnson, CO, Easterling, TR, and Critchlow, CW. "A sister's risk: family history as a predictor of preeclampsia." American journal of obstetrics and gynecology 193.3 Pt 2 (September 2005): 965-972.
PMID
16157095
Source
epmc
Published In
American Journal of Obstetrics & Gynecology
Volume
193
Issue
3 Pt 2
Publish Date
2005
Start Page
965
End Page
972
DOI
10.1016/j.ajog.2005.06.034

Genetic services for familial cancer patients: a follow-up survey of National Cancer Institute Cancer Centers.

PURPOSE: Anecdotal reports suggest that the volume of services offered to individuals concerned with hereditary cancer risk has increased substantially in recent years. As a follow-up to our 1993 survey, we sought to determine how the scope and volume of genetic services has changed between 1993 and 2002. METHODS: We surveyed the 61 National Cancer Institute-designated cancer centers in operation in 2002 using an updated version of the questionnaire from 1993. Analysis included frequencies and summary statistics. RESULTS: The majority of cancer centers responding (46 of 56 centers; 82.1%) provided some genetic services for evaluation of familial cancer, which is a higher proportion than in 1993 (50%; P < .01). Almost all centers (42 of 46 centers; 91.3%) provided services not only to cancer patients and their families, but also to individuals concerned with risk, which is a change (P = .01) from 1993, when 64.7% of centers offered such services. In addition, increases have been found for most other measures of services rendered for familial genetic services. CONCLUSION: As public awareness of cancer susceptibility genes has grown markedly in recent years, the demand has also grown for genetic services to assess familial cancer risk. Major deleterious genetic mutations are rare, and much of the current research in genetic variation focuses on higher prevalence variants that carry lower risks. This may suggest that testing for mutations will move from genetics clinics to primary care and specialty practices. Thus, it is unclear whether the scope and volume of cancer center genetics services will continue to grow as rapidly as they have over the last decade.

Authors
Epplein, M; Koon, KP; Ramsey, SD; Potter, JD
MLA Citation
Epplein, M, Koon, KP, Ramsey, SD, and Potter, JD. "Genetic services for familial cancer patients: a follow-up survey of National Cancer Institute Cancer Centers." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 23.21 (July 2005): 4713-4718.
PMID
16034046
Source
epmc
Published In
Journal of Clinical Oncology
Volume
23
Issue
21
Publish Date
2005
Start Page
4713
End Page
4718
DOI
10.1200/jco.2005.00.133

A sister's risk: Family history as a predictor of hypertensive disorders of pregnancy

Authors
Carr, D; Epplein, M; Johnson, C; Easterling, T; Critchlow, C
MLA Citation
Carr, D, Epplein, M, Johnson, C, Easterling, T, and Critchlow, C. "A sister's risk: Family history as a predictor of hypertensive disorders of pregnancy." December 2004.
Source
crossref
Published In
American Journal of Obstetrics & Gynecology
Volume
191
Issue
6
Publish Date
2004
Start Page
S121
End Page
S121
DOI
10.1016/j.ajog.2004.10.321
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