Browsing by Author "C. Paul"

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    Alcohol, tobacco and breast cancer - Collaborative reanalysis of individual data from 53 epidemiological studies, including 58 515 women with breast cancer and 95 067 women without the disease
    (2002-11-18) N. Hamajima; K. Hirose; K. Tajima; T. Rohan; E. E. Calle; C. W. Heath; R. J. Coates; J. M. Liff; R. Talamini; N. Chantarakul; S. Koetsawang; D. Rachawat; A. Morabia; L. Schuman; W. Stewart; M. Szklo; C. Bain; F. Schofield; V. Siskind; P. Band; A. J. Coldman; R. P. Gallagher; T. G. Hislop; P. Yang; L. M. Kolonel; A. M.Y. Nomura; J. Hu; K. C. Johnson; Y. Mao; S. De Sanjosé; N. Lee; P. Marchbanks; H. W. Ory; H. B. Peterson; H. G. Wilson; P. A. Wingo; K. Ebeling; D. Kunde; P. Nishan; J. L. Hopper; G. Colditz; V. Gajalakshmi; N. Martin; T. Pardthaisong; S. Silpisornkosol; C. Theetranont; B. Boosiri; S. Chutivongse; P. Jimakorn; P. Virutamasen; C. Wongsrichanalai; M. Ewertz; H. O. Adami; L. Bergkvist; C. Magnusson; I. Persson; J. Chang-Claude; C. Paul; D. C.G. Skegg; G. F.S. Spears; P. Boyle; T. Evstifeeva; J. R. Daling; W. B. Hutchinson; K. Malone; E. A. Noonan; J. L. Stanford; D. B. Thomas; N. S. Weiss; E. White; N. Andrieu; A. Brêmond; F. Clavel; B. Gairard; J. Lansac; L. Piana; R. Renaud; A. Izquierdo; P. Viladiu; H. R. Cuevas; P. Ontiveros; A. Palet; S. B. Salazar; N. Aristizabal; A. Cuadros; L. Tryggvadottir; H. Tulinius; A. Bachelot; M. G. Lê; J. Peto; S. Franceschi; F. Lubin; B. Modan; E. Ron; Y. Wax; G. D. Friedman; R. A. Hiatt; F. Levi; T. Bishop; Cancer Research UK; Aichi Cancer Center Hospital and Research Institute; Albert Einstein College of Medicine of Yeshiva University; American Cancer Society; Emory University; IRCCS Centro Di Riferimento Oncologico Aviano; Mahidol University; Johns Hopkins University; University of Queensland; British Columbia Cancer Agency; University of Hawaii System; Canadian Cancer Registries Epidemiology Research Group; Catalan Oncology Institute; Centers for Disease Control and Prevention; Max Delbruck Center for Molecular Medicine; University of Melbourne; Brigham and Women's Hospital; Cancer Institute India; Chiang Mai University; Chulalongkorn University; Kraeftens Bekaempelse; Karolinska Institutet; German Cancer Research Center; University of Otago; Istituto Europeo di Oncologia; Fred Hutchinson Cancer Research Center; Inserm; Girona Cancer Registry; Hospital General de Mexico; Hospital Universitario; Icelandic Cancer Society; Institut de Cancerologie Gustave Roussy; London School of Hygiene & Tropical Medicine; International Agency for Research on Cancer; Chaim Sheba Medical Center Israel; Kaiser Permanente; Institut Universitaire de Medecine Sociale et Preventive Lausanne; Onkoloski institut Ljubljana; Loma Linda University Adventist Health Sciences Center; Skånes universitetssjukhus; Maastricht University; University of the Philippines Manila; Istituto di Ricerche Farmacologiche Mario Negri; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan; Istituto di Statistica Medica e Biometria; Nairobi Centre for Research in Reproduction; National Cancer Institute; National Institute of Child Health and Human Development; National University of Singapore; The Netherlands Cancer Institute; NEW JERSEY STATE DEPT OF HEALTH; New South Wales Cancer Council; Columbia University Medical Center; Ontario Cancer Treatment and Research Foundation; Clinical Trial Service Unit; Radiation Effects Research Foundation Hiroshima; Royal College of General Practitioners' Oral Contraception Study; Universidad de Costa Rica; Medical Center of Fudan University; Shanghai Institute of Planned Parenthood Research; Tianjin Cancer Institute and Hospital; Universitetet i Tromso; Vanderbilt University; University of Athens Medical School; Universidad de Chile; University of Edinburgh; University of Minnesota School of Public Health; The University of North Carolina at Chapel Hill; University of Nottingham; University of Southern California; University of Wisconsin; Organisation Mondiale de la Sante
    Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58 515 women with invasive breast cancer and 95 067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for ≥45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% Cl 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22255 women with breast cancer and 40832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% Cl 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has littte or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver. © 2002 Cancer Research UK.
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    Breast cancer and hormonal contraceptives: Collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies
    (1996-06-22) E. E. Calle; C. W. Heath; H. L. Miracle-McMahill; R. J. Coates; J. M. Liff; S. Franceschi; R. Talamini; N. Chantarakul; S. Koetsawang; D. RachawatRachawat; A. Morabia; L. Schuman; W. Stewart; M. Szklo; C. Bain; F. Schofield; V. Siskind; P. Band; A. J. Coldman; R. P. Gallagher; T. G. Hislop; P. Yang; S. W. Duffy; L. M. Kolonel; A. M.Y. Nomura; M. W. Oberle; H. W. Ory; H. B. Peterson; H. G. Wilson; P. A. Wingo; K. Ebeling; D. Kunde; P. Nishan; G. Colditz; N. Martin; T. Pardthaisong; S. Silpisornkosol; C. Theetranont; B. Boosiri; S. Chutivongse; P. Jimakorn; P. Virutamasen; C. Wongsrichanalai; A. J. McMichael; T. Rohan; M. Ewertz; C. Paul; D. C.G. Skegg; P. Boyle; M. Evstifeeva; J. R. Daling; K. Malone; E. A. Noonan; J. L. Stanford; D. B. Thomas; N. S. Weiss; E. White; N. Andrieu; A. Brêmond; F. Clavel; B. Gairard; J. Lansac; L. Piana; R. Renaud; S. R.P. Fine; H. R. Cuevas; P. Ontiveros; A. Palet; S. B. Salazar; N. Aristizabel; A. Cuadros; A. Bachelot; M. G. Lê; J. Deacon; J. Peto; C. N. Taylor; E. Alfandary; B. Modan; E. Ron; G. D. Friedman; R. A. Hiatt; T. Bishop; J. Kosmelj; M. Primic-Zakelj; B. Ravnihar; J. Stare; W. L. Beeson; G. Fraser; D. S. Allen; R. D. Bulbrook; J. Cuzick; I. S. Fentiman; J. L. Hayward; D. Y. Wang; R. L. Hanson; M. C. Leske; M. C. Mahoney; P. C. Nasca; A. O. Varma; A. L. Weinstein; American Cancer Society; Emory University; IRCCS Centro Di Riferimento Oncologico Aviano; Mahidol University; Johns Hopkins University; University of Queensland; British Colombia Cancer Agency; MRC Biostatistics Unit; University of Hawaii System; Centers for Disease Control and Prevention; Central Institute of Cancer Research; Brigham and Women's Hospital; Chiang Mai University; Chulalongkorn University; Food Science Australia; Kraeftens Bekaempelse; University of Otago; Istituto Europeo di Oncologia; Fred Hutchinson Cancer Research Center; Inserm; Holly Lodge; Hospital General de Mexico; Hospital Universitario; Institut de Cancerologie Gustave Roussy; The Institute of Cancer Research, London; Israel Chaim Sheba Medical Center; Kaiser Permanente; Cancer Research UK; Onkoloski institut Ljubljana; Loma Linda University Adventist Health Sciences Center; Skånes universitetssjukhus; Maastricht University; University of the Philippines Manila; Istituto 'Mario Negri'; Divisione di Statistica Medica e Biometria; Istituto di Statistica Medica e Biometria; Nairobi Centre for Research in Reproduction; National Cancer Institute; National Institute of Child Health and Human Development; National University of Singapore; The Netherlands Cancer Institute; NEW JERSEY STATE DEPT OF HEALTH; Columbia University Medical Center; Ontario Cancer Treatment and Research Foundation; Clinical Trial Service Unit; University of Costa Rica; Medical Center of Fudan University; Shanghai Institute of Planned Parenthood Research; Tianjin Cancer Institute and Hospital; Universitetet i Tromso; Universidad de Chile; University of Edinburgh; The University of North Carolina at Chapel Hill; University of Nottingham; University of Southern California; Uppsala Universitet; University of Wisconsin; Organisation Mondiale de la Sante
    Background: The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed the worldwide epidemiological evidence on the relation between breast cancer risk and use of hormonal contraceptives. Methods: Individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 studies conducted in 25 countries were collected, checked, and analysed centrally. Estimates of the relative risk for breast cancer were obtained by a modification of the Mantel-Haenszel method. All analyses were stratified by study, age at diagnosis, parity, and, where appropriate, the age a woman was when her first child was born, and the age she was when her risk of conception ceased. Findings: The results provide strong evidence for two main conclusions. First, while women are taking combined oral contraceptives and in the 10 years after stopping there is a small increase in the relative risk of having breast cancer diagnosed (relative risk [95% Cl] in current users 1·24 [1·15-1·33], 2p<0·00001; 1-4 years after stopping 1·6 [1·08-1·23], 2p=0·00001; 5-9 years after stopping 1·07 [1·02-1·13], 2p=0·009). Second, there is no significant excess risk of having breast cancer diagnosed 10 or more years after stopping use (relative risk 1·01 [0·96-1·05], NS). The cancers diagnosed in women who had used combined oral contraceptives were less advanced clinically than those diagnosed in women who had never used these contraceptives: for ever-users compared with never-users, the relative risk for tumours that had spread beyond the breast compared with localised tumours was 0·88 (0·81-0·95; 2p=0·002). There was no pronounced variation in the results for recency of use between women with different background risks of breast cancer, including women from different countries and ethnic groups, women with different reproductive histories, and those with or without a family history of breast cancer. The studies included in this collaboration represent about 90% of the epidemiological information on the topic, and what is known about the other studies suggests that their omission has not materially affected the main conclusions. Other features of hormonal contraceptive use such as duration of use, age at first use, and the dose and type of hormone within the contraceptives had little additional effect on breast cancer risk, once recency of use had been taken into account. Women who began use before age 20 had higher relative risks of having breast cancer diagnosed while they were using combined oral contraceptives and in the 5 years after stopping than women who began use at older ages, but the higher relative risks apply at ages when breast cancer is rare and, for a given duration of use, earlier use does not result in more cancers being diagnosed than use beginning at older ages. Because breast cancer incidence rises steeply with age, the estimated excess number of cancers diagnosed in the period between starting use and 10 years after stopping increases with age at last use: for example, among 10 000 women from Europe or North America who used oral contraceptives from age 16 to 19, from age 20 to 24, and from age 25 to 29, respectively, the estimated excess number of cancers diagnosed up to 10 years after stopping use is 0·5 (95% Cl 0·3-0·7), 1·5 (0·7-2·3), and 4·7 (2·7-6·7). Up to 20 years after cessation of use the difference between ever-users and never-users is not so much in the total number of cancers diagnosed, but in their clinical presentation, with the breast cancers diagnosed in ever-users being less advanced clinically than those diagnosed in never-users. The relation observed between breast cancer risk and hormone exposure is unusual, and it is not possible to infer from these data whether it is due to an earlier diagnosis of breast cancer in ever-users, the biological effects of hormonal contraceptives, or a combination of reasons. Interpretation: Women who are currently using combined oral contraceptives or have used them in the past 10 years are at a slightly increased risk of having breast cancer diagnosed, although the additional cancers diagnosed tend to be localised to the breast. There is no evidence of an increase in the risk of having breast cancer diagnosed 10 or more years after cessation of use, and the cancers diagnosed then are less advanced clinically than the cancers diagnosed in never-users.
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    Breast cancer and hormone replacement therapy: Collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer
    (1997-10-11) E. E. Calle; C. W. Heath; R. J. Coates; J. M. Liff; S. Franceschi; R. Talamini; N. Chantarakul; S. Koetsawang; D. Rachawat; A. Morabia; L. Schuman; W. Stewart; M. Szklo; C. Bain; F. Schofield; V. Siskind; P. Band; A. J. Coldman; R. P. Gallagher; T. G. Hislop; P. Yang; S. W. Duffy; L. M. Kolonel; A. M.Y. Nomura; M. W. Oberle; H. W. Ory; H. B. Peterson; H. G. Wilson; P. A. Wingo; K. Ebeling; D. Kunde; P. Nishan; G. Colditz; N. Martin; T. Pardthaisong; S. Silpisornkosol; C. Theetranont; B. Boosiri; S. Chutivongse; P. Jimakorn; P. Virutamasen; C. Wongsrichanalai; A. J. McMichael; T. Rohan; M. Ewertz; C. Paul; D. C.G. Skegg; G. F.S. Spears; P. Boyle; M. Evstifeeva; J. R. Daling; W. B. Hutchinson; K. Malone; E. A. Noonan; J. L. Stanford; D. B. Thomas; N. S. Weiss; E. White; N. Andrieu; A. Bràmond; F. Clavel; B. Gairard; J. Lansac; L. Piana; R. Renaud; S. R.P. Fine; H. R. Cuevas; P. Ontiveros; A. Palet; S. B. Salazar; N. Aristizabel; A. Cuadros; A. Bachelot; M. G. Lê; J. Deacon; J. Peto; C. N. Taylor; E. Alfandary; B. Modan; E. Ron; G. D. Friedman; R. A. Hiatt; T. Bishop; J. Kosmelj; M. Primic-Zakelj; B. Ravnihar; J. Stare; W. L. Beeson; G. Fraser; R. D. Bulbrook; J. Cuzick; I. S. Fentiman; J. L. Hayward; D. Y. Wang; R. L. Hanson; M. C. Leske; M. C. Mahoney; P. C. Nasca; A. O. Varma; A. L. Weinstein; American Cancer Society; Emory University; IRCCS Centro Di Riferimento Oncologico Aviano; Mahidol University; Johns Hopkins University; University of Queensland; British Colombia Cancer Agency; MRC Biostatistics Unit; University of Hawaii System; Centers for Disease Control and Prevention; Central Institute of Cancer Research; Harvard Medical School; Chiang Mai University; Chulalongkorn University; Food Science Australia; Kraeftens Bekaempelse; University of Otago; Istituto Europeo di Oncologia; Fred Hutchinson Cancer Research Center; Inserm; Holly Lodge; Hospital General de Mexico; Hospital Universitario; Institut de Cancerologie Gustave Roussy; The Institute of Cancer Research, London; Israel Chaim Sheba Medical Center; Kaiser Permanente; Cancer Research UK; Onkoloski institut Ljubljana; Loma Linda University Adventist Health Sciences Center; Long Island Breast Cancer Study; Skånes universitetssjukhus; Maastricht University; University of the Philippines Manila; Istituto 'Mario Negri'; Divisione di Statistica Medica e Biometria; Istituto di Statistica Medica e Biometria; Nairobi Centre for Research in Reproduction; National Cancer Institute; National Institute of Child Health and Human Development; National University of Singapore; The Netherlands Cancer Institute; NEW JERSEY STATE DEPT OF HEALTH; Columbia University Medical Center; Ontario Cancer Treatment and Research Foundation; Clinical Trial Service Unit; Royal College of General Practitioners Oral Contraception Study; University of Costa Rica; Medical Center of Fudan University; Shanghai Institute of Planned Parenthood Research; Tianjin Cancer Institute and Hospital; Universitetet i Tromso; Universidad de Chile; University of Edinburgh; The University of North Carolina at Chapel Hill; University of Nottingham; University of Southern California; University of Wisconsin; Organisation Mondiale de la Sante; Karolinska Institutet; Institut Universitaire de Medecine Sociale et Preventive Lausanne; London School of Hygiene & Tropical Medicine; Radiation Effects Research Foundation Hiroshima; University of Athens Medical School
    Background. The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed about 90% of the worldwide epidemiological evidence on the relation between risk of breast cancer and use of hormone replacement therapy (HRT). Methods. Individual data on 52,705 women with breast cancer and 108,411 women without breast cancer from 51 studies in 21 countries were collected, checked, and analysed centrally. The main analyses are based on 53,865 postmenopausal women with a known age at menopause, of whom 17,830 (33%) had used HRT at some time. The median age at first use was 48 years, and 34% of ever-users had used HRT for 5 years or longer. Estimates of the relative risk of breast cancer associated with the use of HRT were obtained after stratification of all analyses by study, age at diagnosis, time since menopause, body-mass index, parity, and the age a woman was when her first child was born. Findings. Among current users of HRT or those who ceased use 1-4 years previously, the relative risk of having breast cancer diagnosed increased by a factor of 1.023 (95% CI 1.011-1.036; 2p = 0.0002) for each year of use; the relative risk was 1.35 (1.21-1.49; 2p = 0.00001) for women who had used HRT for 5 years or longer (average duration of use in this group 11 years). This increase is comparable with the effect on breast cancer of delaying menopause, since among never-users of HRT the relative risk of breast cancer increases by a factor of 1.028 (95% CI 1.021-1.034) for each year older at menopause. 5 or more years after cessation of HRT use, there was no significant excess of breast cancer overall or in relation to duration of use. These main findings did not vary between individual studies. Of the many factors examined that might affect the relation between breast cancer risk and use of HRT, only a woman's weight and body-mass index had a material effect: the increase in the relative risk of breast dancer associated with long durations of use in current and recent users was greater for women of lower than of higher weight or body-mass index. There was no marked variation in the results according to hormonal type or dose but little information was available about long durations of use of any specific preparation. Cancers diagnosed in women who had ever used HRT tended to be less advanced clinically than those diagnosed in never-users. In North America and Europe the cumulative incidence of breast cancer between the ages of 50 and 70 in never-users of HRT is about 45 per 1000 women. The cumulative excess numbers of breast cancers diagnosed between these ages per 1000 women who began use of HRT at age 50 and used it for 5, 10, and 15 years, respectively, are estimated to be 2 (95% CI 1-3), 6 (3-9), and 12 (5-20). Whether HRT affects mortality from breast cancer is not known. Interpretation. The risk of having breast cancer diagnosed is increased in women using HRT and increases with increasing duration of use. This effect is reduced after cessation of use of HRT and has largely, if not wholly, disappeared after about 5 years. These findings should be considered in the context of the benefits and other risks associated with the use of HRT.