Lessons learnt from a three-year pilot field epidemiology training programme.

Problem: The Pacific region has widely dispersed populations, limited financial and human resources and a high burden of disease. There is an urgent need to improve the availability, reliability and timeliness of useable health data.

Context: The purpose of this paper is to share lessons learnt from a three-year pilot field epidemiology training programme that was designed to respond to these Pacific health challenges.

Shift work and breast cancer among women textile workers in Shanghai, China.

Purpose: Although night-shift work has been associated with elevated risk of breast cancer in numerous epidemiologic studies, evidence is not consistent. We conducted a nested case-cohort study to investigate a possible association between shift work including a night shift and risk of breast cancer within a large cohort of women textile workers in Shanghai, China.

Methods: The study included 1,709 incident breast cancer cases and 4,780 non-cases.

Occupational exposure to magnetic fields and breast cancer among women textile workers in Shanghai, China.

Exposure to magnetic fields (MFs) is hypothesized to increase the risk of breast cancer by reducing production of melatonin by the pineal gland. A nested case-cohort study was conducted to investigate the association between occupational exposure to MFs and the risk of breast cancer within a cohort of 267,400 female textile workers in Shanghai, China. The study included 1,687 incident breast cancer cases diagnosed from 1989 to 2000 and 4,702 noncases selected from the cohort.

Mammographic breast density and tolerance for short-term postmenopausal hormone therapy suspension.

Background: Breast density tends to decrease when women stop taking hormone therapy (HT). Some women find HT cessation difficult to tolerate, possibly because of fluctuations in endogenous hormone levels and vasomotor symptoms. We hypothesized that women with dense breasts might have lower tolerance for short-term HT suspension than do women with fatty breasts.

Physical activity, physical exertion, and miscarriage risk in women textile workers in Shanghai, China.

Background: Strenuous occupational physical activity and physical demands may be risk factors for adverse reproductive outcomes.

Methods: A retrospective study in the Shanghai, China textile industry study collected women's self-reported reproductive history. Occupational physical activity assessment linked complete work history data to an industry-specific job-exposure matrix.

Short-term hormone therapy suspension and mammography recall: a randomized trial.

Background: Without population-based evidence, some clinicians recommend short-term suspension of hormone therapy to improve the performance of mammography. Hormone therapy increases breast density, and abnormal screening mammograms are more common among women with denser breasts and among women using hormone therapy.

Objective: To test whether 1 to 2 months of hormone therapy suspension before screening mammography decreases additional mammographic imaging (recall) in women age 45 to 80 years.

Short-term (1-2 mo) hormone therapy cessation before mammography.

Objective: Some healthcare providers recommend hormone therapy (HT) cessation before mammography to improve performance. Our objective was to evaluate characteristics of women willing to consider HT cessation before screening mammography.

Methods: We performed a randomized clinical trial, the Radiological Evaluation and Breast Density study, within an integrated health plan (2004-2007).

Occupational risk factors for endometrial cancer among textile workers in Shanghai, China.

Objective: A case-cohort study was conducted to investigate associations between occupational exposures and endometrial cancer nested within a large cohort of textile workers in Shanghai, China.

Methods: The study included 176 incident endometrial cancer cases diagnosed from 1989 to 1998 and a randomly-selected age-stratified reference subcohort (n = 3,061). Study subjects' complete work histories were linked to a job-exposure matrix developed specifically for the textile industry to assess occupational exposures.

Occupational exposures and ovarian cancer in textile workers.

Background: Occupational risk factors for ovarian cancer have been investigated only to a limited extent. We conducted a case-cohort study to examine associations between occupational exposures and ovarian cancer in the textile industry.

Methods: We compared 261 incident ovarian cancer cases diagnosed between 1989 and 1998 with an age-stratified reference subcohort (n = 3199) from a cohort of 267,400 textile workers in Shanghai, China.

Occupational exposures and breast cancer among women textile workers in Shanghai.

Background: Breast cancer incidence rates have been increasing in China over the past 2 decades. Most studies have focused on reproductive, dietary, and genetic risk factors. Little is known about the contribution of occupational exposures.

Lung cancer risk among female textile workers exposed to endotoxin.

Background: Reduced risk of lung cancer among workers in the cotton textile industry has been observed since the 1970s. Bacterial endotoxin, a contaminant of raw cotton fiber and cotton dust, has been proposed as a protective agent that may act through the innate and acquired immune systems. We examine the association between endotoxin exposure and lung cancer risk in a cohort of female textile workers.

Risks of biliary tract cancer and occupational exposures among Shanghai women textile workers: a case-cohort study.

Background: Biliary tract cancer (BTC) is a relatively rare malignancy worldwide. Little is known about potential etiologic contributions of occupational exposures.

Methods: The associations between occupational exposures to textile dusts and chemicals and BTC are investigated in a cohort of 267,400 women textile workers in Shanghai, China.

Brain tumors and occupational exposures in a cohort of female textile workers in Shanghai, China.

Objectives: This study assessed the associations between brain tumors and specific processes and exposures among female textile workers in Shanghai, China.

Methods: A case-cohort study was conducted that was nested in a cohort of textile workers originally included in a randomized trial of breast self-examination. Incident brain tumor cases (N=114) were identified from 1989 to 1998 from a tumor and death registry operated by the Shanghai Textile Industry Bureau.

Occupational risk factors for esophageal and stomach cancers among female textile workers in Shanghai, China.

The authors evaluated associations between occupational exposures in the textile industry and the risks of esophageal cancer and stomach cancer. The authors conducted a case-cohort study nested in a cohort of female textile workers in Shanghai, China. One hundred and two workers with incident esophageal cancer and 646 workers with incident stomach cancer diagnosed between 1989 and 1998 were compared with an age-stratified reference subcohort (n = 3,188).

Occupational exposures and risks of liver cancer among Shanghai female textile workers--a case-cohort study.

Background: Liver cancer is the fifth most frequent malignancy worldwide. Viral hepatitis B and C, alcohol, and aflatoxin are the major established risk factors. Little is known about the aetiological contributions of occupational exposures, as previous occupational epidemiological studies of liver cancer suggest few agent-specific associations.

Dietary and other risk factors in women having fibrocystic breast conditions with and without concurrent breast cancer: a nested case-control study in Shanghai, China.

Risk of breast cancer is increased in women with proliferative benign breast conditions. Most of these conditions, however, do not progress to breast cancer. The purpose of our study was to identify factors possibly associated with this progression.

Food and botanical groupings and risk of breast cancer: a case-control study in Shanghai, China.

Breast cancer incidence rates more than double in Chinese women as they migrate from China to Hong Kong to the United States, suggesting that environmental factors contribute to the international variation in breast cancer incidence. Several dietary factors, which differ between the United States and the Chinese population, including intake of soy, meat, and fruits and vegetables, have been suggested to affect breast cancer risk. This report describes results from a case-control study of diet and risk of breast cancer nested in a randomized trial of breast self exam in Shanghai, China.

A case-control study of risk factors for fibrocystic breast conditions: Shanghai Nutrition and Breast Disease Study, China, 1995-2000.

This study was conducted to identify reproductive and dietary factors associated with benign proliferative mammary epithelial cell changes. Subjects were women enrolled in a randomized trial of breast self-examination in Shanghai, China. Women who developed fibrocystic breast conditions classified as nonproliferative (175 women), proliferative (181 women), or proliferative with atypia (33 women) between 1995 and 2000 and 1,070 unaffected trial participants were administered general risk factor and food frequency questionnaires.

Development of a cancer research study in the Shanghai textile industry.

This article describes the development of a cancer study among Shanghai textile workers. Due to the organization of work between 1949 and the 1980s, and superior record-keeping practices, it is possible to track textile workers' job tasks and workplace exposures over virtually the entirety of their working lives. The authors' experiences utilized important relationships developed over more than ten years to access work exposures and cancer outcomes.

Urinary equol excretion in relation to 2-hydroxyestrone and 16alpha-hydroxyestrone concentrations: an observational study of young to middle-aged women.

Approximately one-third to one-half of individuals harbor the colonic bacteria that are capable of metabolizing the soy isoflavone daidzein to equol. Results of prior studies suggest beneficial effects of producing equol in relation to breast cancer risk, potentially through effects on endogenous hormones. High urinary excretion of 2-hydroxyestrone (2-OH E(1)) relative to 16alpha-hydroxyestrone (16alpha-OH E(1)) has been associated with a reduced risk of breast cancer.

Overnight urinary isoflavone excretion in a population of women living in the United States, and its relationship to isoflavone intake.

Dietary isoflavones are biologically active in humans, but few observational data exist on the relationship between isoflavone intake and excretion in Western populations. We examined associations between self-reported soy intakes and overnight urinary isoflavone excretion in a population-based sample of western Washington State women, and we investigated the usefulness of one versus two overnight urine samples, collected 48 h apart, as a biomarker of intake. Isoflavones (genistein, daidzein, O-desmethylangolensin, and equol) were measured in two overnight urine collections from 363 women recruited from a health maintenance organization.