Overstating the evidence for lung cancer screening: the International Early Lung Cancer Action Program (I-ELCAP) study.

Last year, the New England Journal of Medicine ran a lead article reporting that patients with lung cancer had a 10-year survival approaching 90% if detected by screening spiral computed tomography. The publication garnered considerable media attention, and some felt that its findings provided a persuasive case for the immediate initiation of lung cancer screening. We strongly disagree.

Rosuvastatin: an independent analysis of risks and benefits.

Background: Although the effectiveness of statins is well established, analyses of spontaneous adverse event reports have recently questioned the safety of rosuvastatin.

Methods And Results: We evaluated the risks and benefits of rosuvastatin and compared it with other statins presently on the market. Information was obtained from a search of medical and scientific literature that produced 3001 entries, of which 591 publications containing particularly relevant data were identified, and from the US Food and Drug Administration (FDA) Adverse Events Reporting System (AERS) and Spontaneous Reporting System through June 30, 2004.

Assessment of a national health interview survey-based method of measuring community socioeconomic status.

Purpose: Increasingly researchers are interested in assessing the role of community socioeconomic status (SES) in poor health outcomes, above and beyond the influence of low individual SES. However, the feasibility of conducting these multi-level studies is often limited by restrictions on release of confidential identifiers for linkage to census data, resources for the linkage, and the availability of data sources with individual SES measures. This study assessed a new method of measuring community socioeconomic status (SES) that can be used with the publicly available National Health Interview Survey (NHIS) and preserves confidentiality and can be used with individual SES measures from the NHIS.

Does stage at diagnosis influence the observed relationship between socioeconomic status and breast cancer incidence, case-fatality, and mortality?

Historically, lower socioeconomic status (SES) has been reported to be associated with decreased breast cancer incidence and mortality and increased case-fatality, although recent trends in breast cancer screening and treatment may alter these relationships. This study assessed the associations between SES and breast cancer incidence, case-fatality, and mortality by stage of disease at diagnosis using recent data in the United States. Breast cancer incidence and survival data from the Surveillance, Epidemiology, and End Results (SEER) tumor registry for black and white women aged 55 and above were linked to county level SES and population data based on place of residence.

Comparative epidemiology of selected midline congenital abnormalities.

We present comparative epidemiologic characteristics of five congenital abnormalities that have been suggested to result from midline abnormal developmental disturbances: esophageal atresia with or without tracheoesophageal fistula (EA/TEF), imperforate anus with or without fistula (IA/F), omphalocele (OM), bladder exstrophy (BE), and diaphragmatic hernia (DH). The purpose was to assess the extent of epidemiologic similarities among these five defects. Data were collected as part of a population-based case-control study of infants with these defects born to mothers residing in Maryland, Washington, D.

Genetic-epidemiologic study of omphalocele and gastroschisis: evidence for heterogeneity.

On the basis of clinical manifestations, epidemiologic characteristics, and the presence of additional malformations, omphalocele (OM) and gastroschisis (GA) are considered casually and pathogenetically distinct abdominal wall defects. More than 50% of infants with OM have additional defects, but only about 15% of those with GA do. To evaluate whether there is heterogeneity between isolated and multiply affected cases of OM and GA, we analyzed epidemiologic characteristics and familial risks of major defects for 82 OM and 81 GA cases drawn from a population-based study in the Maryland-Washington, DC-Northern Virginia area and born from 1980 through June 1987.

Ethical and professional issues in the changing practice of epidemiology.

New ethical and professional issues are affecting epidemiology today as a result of the changing social and scientific context in which epidemiology is practiced. These issues arise in interpreting the findings of epidemiologic studies, dealing with potential conflicts of interest, fulfilling obligations to the people studied, publishing study results and providing others access to the data after studies have been completed. The epidemiologist is also faced with new challenges including the need to communicate new information on health risks to non-epidemiologists, and to apply her epidemiologic expertise and study findings to the development of public policy.

Evaluating the evidence for the effectiveness of prevention.

This report reviews a number of issues that should be considered in evaluating the evidence for the effectiveness of primary and secondary prevention. In evaluating primary prevention, changes in disease incidence are the ideal index but mortality may also be a useful surrogate in certain cases. Both relative risk and attributable risk are valuable concepts in evaluating the benefits of primary prevention.

Consumption of methylxanthine-containing beverages and risk of pancreatic cancer.

This paper reviews published studies of a possible relationship of consumption of methylxanthine-containing beverages, primarily coffee, to risk of pancreatic cancer (PC). Certain ecologic studies suggested a possible relation of pancreatic cancer mortality and coffee consumption by country. The findings from case-control studies are not entirely consistent; in general, no significant increased risk with a clear dose-response relationship is reported, but some of the studies suggest the possibility of some increase in risk.

Morbidity among breech infants according to method of delivery.

To determine whether vaginally born breech infants are at increased risk for morbid events as compared with breech infants delivered by cesarean, we studied 1240 singleton breech infants without congenital anomalies delivered in Northern California Kaiser Permanente Medical Care Program hospitals during 1976-1977. Medical record review provided information on indications for method of delivery, delivery complications and injuries, neonatal complications, and neurologic sequelae up to 4 years of age. The relative risk estimates for asphyxia (1.

Geographic and environmental factors in pediatric cancer.

It is important to determine the relative contributions of genetic and environmental factors to the etiology of childhood cancer in order to elucidate the pathogenic mechanisms involved and to develop effective means of primary prevention. Geographic differences in cancer incidence as well as changes in incidence over calendar time have long been used to generate clues to possible etiologic agents. The important role of genetic factors in childhood cancer is clear, and is exemplified by the observations in retinoblastoma.

Diet and other risk factors for cancer of the pancreas.

The findings of a case - control study of cancer of the pancreas, which was conducted in the Baltimore metropolitan area, are reported. Two hundred one patients with pancreatic cancer were matched on age (+/- 5 years), race, and sex to hospital and non-hospital controls, the latter selected by random-digit-dialing (RDD). All subjects were interviewed regarding diet, beverage consumption, occupational and environmental exposures, and medical and surgical history.

General concepts for use of markers in clinical trials.

Both indirect and direct methods have been widely employed for measuring medication compliance. Indirect methods include therapeutic or preventive outcome, assessment by the physician, interview with the patient, whether or not the prescription was filled, and a count of remaining pills. In many situations, direct methods may be feasible, including measurement of blood or serum levels or testing urine for excretion of the medication itself, a metabolic by-product, or a marker or tracer that has been added to the medication for detection purposes.

Estrogen use and myocardial infarction risk: a case-control study.

A case-control study was conducted to examine the relationship of estrogen use to myocardial infarction in postmenopausal white women. After exclusion of proxy responses and of controls with discharge diagnoses of gynecologic or gallbladder diseases, there remained 39 matched sets (33 pairs and 6 triplets). The unadjusted relative odds ratio (RO) for past estrogen use was found to be 0.

Breast cancer incidence in women with a history of progesterone deficiency.

In order to investigate the nature of the association of involuntarily delayed first birth and risk of breast cancer, 1083 white women who had been evaluated and treated for infertility from 1945-1965 were followed prospectively through April 1978 to ascertain their breast cancer incidence. These women were categorized as to the cause of infertility into two groups, those with endogenous progesterone deficiency (PD) and those with nonhormonal causes (NH). Women in the PD group had 5.