A rhinovirus outbreak among residents of a long-term care facility

OBJECTIVE

To describe the epidemiology of and clinical findings associated with a rhinovirus outbreak that occurred among institutionalized elderly persons.

DESIGN

Retrospective review of medical records and nursing surveillance reports.

SETTING

A 685-bed, long-term care facility for veterans and their spouses.

PATIENTS

33 persons from whom rhinovirus was cultured.

MEASUREMENTS

Throat and nasopharyngeal virus culture; review of medical records to determine underlying diseases, signs and symptoms of respiratory illness, illness duration, and interventions during illness; and review of nursing surveillance reports to determine room locations of ill persons.

RESULTS

Between 14 August and 2 September 1993, the number of respiratory illnesses increased. Throat and nasopharyngeal virus cultures were taken from 67 ill residents; 33 cultures yielded rhinovirus, and no other respiratory virus was isolated. Geographic clustering of persons infected with rhinovirus was observed. Of those persons with rhinovirus infections, 100% had upper respiratory symptoms, 34% had gastrointestinal symptoms, 71% had systemic symptoms, 66% had lower respiratory symptoms (including productive cough), and 52% had new abnormalities on lung auscultation. The 17 persons with rhinovirus infection who had chronic obstructive pulmonary disease had more severe illnesses: Five (29%) required glucocorticoid or bronchodilator therapy for illness-associated bronchospasm; 2 required transfer out of the facility; 1 developed a radiographically documented infiltrate; and 1 died of respiratory failure.

CONCLUSIONS

Rhinovirus may cause epidemic, clinically important respiratory illness in nursing homes residents. A large proportion of residents may become ill, and infection may be severe in persons with underlying lung disease.

Pooled reanalysis of cancer mortality among five cohorts of workers in wood-related industries

OBJECTIVES

To provide more information regarding the risk of cancer associated with wood dust, a pooled reanalysis of data from five cohort studies was performed.

METHODS

The combined cohort consisted of 28,704 persons from five studies: British furniture workers, members of the union representing furniture workers in the United States, two cohorts of plywood workers, and one of wood model makers, among whom 7665 deaths occurred. Pooled analyses were carried out for all of the cohorts combined, the two furniture worker cohorts combined, and the two plywood workers cohorts combined.

RESULTS

Significant excesses of nasal [observed 11, standardized mortality ratio (SMR) 3.1, 95% confidence interval (95% CI) 1.6-5.6] and nasopharyngeal (observed 9, SMR 2.4, 95% CI 1.1-4.5) cancer were observed. That for nasal cancer appeared to be associated with exposure to wood dust but was based solely on cases from the British furniture worker cohort, while that of nasopharyngeal cancer was observed for furniture and plywood workers and was associated with both high and low probability of wood dust exposure. Some support for an excess risk of multiple myeloma was also observed but was less clearly associated with wood dust exposure. No excesses of lung, larynx, stomach, or colon cancer were found to be associated with any surrogate indicators of wood dust exposure.

CONCLUSIONS

Workers exposed to wood dust may have an excess risk of nasopharyngeal cancer and multiple myeloma in addition to sinonasal cancer. The limitations of this study would tend to obscure relationships, rather than create false positive findings.

Concentrations of apolipoprotein AI, AII, and E in plasma and lipoprotein fractions of alcoholic patients: gender differences in the effects of alcohol

Previous studies have shown that plasma levels of high-density lipoprotein (HDL) cholesterol and the two major protein components of HDLs, i.e., apolipoproteins AI and AII, were elevated in male alcoholic patients without serious liver injury. By contrast, alcohol effect on apolipoprotein E remains unclear. Apolipoprotein E is a major component of very low-density lipoprotein (VLDL) and a minor component of human high-density lipoprotein. It plays a critical role in lipoprotein metabolism through cellular lipoprotein receptors. Furthermore, previous works were carried out mostly with male subjects, whereas alcohol effects on serum apolipoproteins in female subjects have not yet been adequately addressed. In this study, we have raised antibodies specifically to recognize human apolipoprotein AI, AII, and E, respectively, to quantify apolipoprotein concentrations in plasma and lipoprotein fractions of male and female alcoholic patients. We have also measured plasma apolipoprotein concentrations in patients who had abstained from alcohol while in the hospital. Our results showed the following: (1) plasma concentrations of apolipoprotein AI and AII were significantly elevated yet plasma apolipoprotein E decreased (33%) significantly (P < .01) in male alcoholic patients; (2) apolipoprotein AI concentrations in female nondrinking control subjects were higher than in male controls, and the concentrations of apolipoprotein AI in female alcoholic patients were not significantly elevated over those of female controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Are increases in mammographic screening still a valid explanation for trends in breast cancer incidence in the United States?

A number of studies have attributed much of the sharp increase in breast cancer incidence in the United States during the 1980s to the increased detection through mammography. The most recent breast cancer data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program show that the incidence trend has slowed, while results from the National Health Interview Survey (NHIS) of 1987 and 1990 indicate that the percentage of women receiving mammograms continues to increase. This phenomenon suggested the need to reassess the relationship between increasingly early detection of breast cancer and overall incidence trends. A polynomial age-cohort model was used to establish the secular trend in incidence rates excluding the impact of recent increases in detection due to the rising use of mammography. Based on the model, the incidence trend in the youngest age group (40 to 49 years) would peak and then begin to decline in the early 1980s. This pattern would manifest itself later in successively older age groups as these younger cohorts age. Breast cancer trends are seen to be generally consistent with the impact of the increased use of mammography when its effect is superimposed upon the background of declining or slowing secular trends. These results support previous reports linking incidence rates with the increase in screening-mammography.

Recent cancer trends in the United States

BACKGROUND

Cancer incidence rates have been reported to be increasing in the United States, although trends vary according to form of cancer.

PURPOSE

We identify the cancers accounting for the rising incidence, quantify the changes that have occurred from the mid-1970s to the early 1990s, and contrast incidence and mortality trends to provide clues to the determinants of the temporal patterns.

METHODS

Sex-, race-, and age-specific and age-adjusted incidence rates for the 5-year periods 1987-1991 versus 1975-1979 were calculated for 28 cancers among men and 30 cancers among women using data from the Surveillance, Epidemiology, and End Results (SEER) Program of cancer registration covering about 10% of the U.S. population. Similar rates were computed using national mortality data. Cancers were ranked according to the change in incidence rates over the two periods.

RESULTS

Age-adjusted incidence rates for all cancers combined increased by 18.6% among males and 12.4% among females from 1975-1979 to 1987-1991, due largely to rising rates for prostate cancer among men and for breast and lung cancers among women. National mortality rates for all cancers combined rose less steeply, 3% and 6% among men and women, respectively, driven mostly by continuing increases in lung cancer mortality, while death rates for the majority of the cancers were steady or declining. Total cancer incidence rose at all ages, but with different tumors responsible for the increases at different ages: leukemia and brain/nervous system cancer among children; testicular cancer, nonmelanoma skin cancer (largely Kaposi's sarcoma), non-Hodgkin's lymphoma, and melanoma among young and middle-aged adults; and prostate, breast, and lung cancers among older individuals. In contrast, mortality rates for all cancers combined declined among both males and females under age 55 years, increasing only among older persons.

CONCLUSIONS

Trends in cancer incidence and mortality differ. For most cancers, incidence rates are rising, while mortality rates are generally stable or declining.

IMPLICATIONS

Much of the recent increase in cancer incidence can be explained by known factors. Improved detection appears to account for most of the increases in breast cancer among women and prostate cancer among men. On the other hand, cigarette smoking is the major determinant of the rise in lung cancer among women, acquired immunodeficiency syndrome has led to increases in non-Hodgkin's lymphoma and Kaposi's sarcoma among young and middle-aged men, and sunlight exposure patterns have affected the trends in melanoma. Some trends remain unexplained, however, and may reflect changing exposures to carcinogens yet to be identified and clarified.

Erythropoietin modulation of intracellular calcium: a role for tyrosine phosphorylation

We have reported that erythropoietin induces a dose-dependent increase in cytosolic calcium ([Cai]) in single human peripheral blood BFU-E derived erythroblasts which is specific for stage of differentiation and that this increase is modulated by erythropoietin through an ion channel permeable to Ca2+. Here, the role of protein phosphorylation in the increase in intracellular free calcium [Cai] stimulated by erythropoietin was studied with digital video imaging. Preincubation of day 10 erythroblasts with a broad inhibitor of serine/threonine and tyrosine kinases, staurosporine (100 nM), blocked the increase in [Cai] over 20 min following erythropoietin stimulation. However, erythropoietin-induced calcium influx was unaffected by preincubation of cells with specific inhibitions of protein kinase C (calphostin C) or the cAMP- or cGMP-dependent kinases (KT 5720, HA 1004), and [Cai] did not increase following stimulation with phorbol 12-myristate 13-acetate (PMA) or dibutyryl cAMP. These results suggest that neither protein kinase C nor protein kinase A mediate the erythropoietin-induced [Cai] increase. In contrast, preincubation with genistein, a tyrosine kinase inhibitor, blocked the erythropoietin induced increase in [Cai]. To further study calcium entry in erythroblasts, we determined mastoparan, a peptide from wasp venom, induced a dose-dependent rise in [Cai] in erythroblasts which required external calcium. Stimulation of erythroid precursors with 10 microM mastoparan resulted in an increase in [Cai] from 52 +/- 3 nM to 214 +/- 36 nM which peaked at 20 min. The mastoparan-induced [Cai] increase was also dependent on tyrosine phosphorylation since it was blocked by preincubation with genistein. These results demonstrate that both erythropoietin and mastoparan stimulate calcium entry by a mechanism which has a genistein sensitive step and suggest that tyrosine kinase activation is required for the rise in [Cai] to occur.

A method for partitioning cancer mortality trends by factors associated with diagnosis: an application to female breast cancer

U.S. cancer mortality data derived from information recorded on death certificates are frequently relied upon as an indicator of progress against cancer. A limitation of this measure is the lack of information pertaining to the onset of disease, such as year-of-diagnosis, age-at-diagnosis, stage of disease at diagnosis and histology of lesions. However, population-based cancer registries collect these types of data and allow the calculation of an incidence-file based mortality rate. This incidence-based mortality rate allows a partitioning of mortality by variables associated with the cancer onset. Breast cancer incidence-based mortality measures are created and compared to mortality rates based on death certificates over a comparable time period. Novel mortality measures, such as mortality rates by stage-at-diagnosis, age-at-diagnosis and year-of-diagnosis, are used to illustrate the value of this approach.

Steel factor affects SCL expression during normal erythroid differentiation

Steel factor is one of the growth factors that controls the proliferation and differentiation of hematopoietic cells and SCL, also known as Tcl-5 or Tal-1, is a transcription factor involved in erythropoiesis. In this report, we studied the role of SCL in the proliferation of human peripheral blood burst-forming unit-erythroid (BFU-E) and the effects of Steel factor on SCL expression in proliferating erythroid cells. BFU-E-derived colonies increase progressively in size, as determined by cell number, from day 7 to day 14 of culture, with the greatest increase in colony size (10-fold expansion) occurring between day 7 and day 10. SCL protein levels in BFU-E-derived cells were highest in day 7 cells and decreased progressively from day 7 to day 14 of culture, suggesting an association of SCL with erythroid proliferation. In contrast, SCL mRNA levels did not decrease significantly between day 7 and day 14 cells, suggesting that posttranscriptional mechanisms are largely responsible for the decrease in SCL protein observed. The role of SCL in Steel factor-induced erythroid proliferation was then examined. In BFU-E-derived colonies cultured with Steel factor, colony size was significantly increased compared to control. In day 7 and day 10 erythroid precursors cultured with Steel factor, SCL protein was increased significantly compared to control. The increase in SCL protein levels in early erythroid precursors stimulated with Steel factor suggests one mechanism through which Steel factor may enhance normal erythroid proliferation. SCL mRNA levels assessed by Northern blot in day 7 cells did not increase significantly in response to Steel factor stimulation, suggesting that posttranscriptional mechanisms may also be important in the increase in SCL protein observed in response to Steel.

NK1 and NK2 receptors contribute to C-fibre evoked slow potentials in the spinal cord

Small diameter primary afferents produce slow synaptic potentials in spinal neurones. These can be recorded as prolonged ventral root potentials (VRPs) in the isolated neonatal rat spinal cord preparation. The VRP elicited by stimulating C-fibres consists of two phases: an early phase comprising a monosynaptic and a short polysynaptic response identical to that elicited by low threshold A beta fibres and a late phase which has an initial component (0.1-1 s) which is sensitive to N-methyl-D-aspartic acid receptor antagonism and a very long lasting second component (1-20 s) which is resistant to these antagonists. We now demonstrate that the slowest component of the VRP is significantly reduced by both NK1 and NK2 tachykinin receptor antagonists and as a consequence, tachykinins have a particular contribution to the cumulative depolarization produced by low frequency (1 Hz) C-fibre stimulation.

Mechanisms of erythropoietin signal transduction: involvement of calcium channels

Erythropoietin (Epo) induces a dose-dependent increase in intracellular free calcium concentration ([Cai]) in single human BFU-E derived erythroblasts, which is specific for stage of differentiation and mediated through a voltage-independent ion channel permeable to calcium. This minireview examines the regulation of calcium channels by Epo during normal erythroid differentiation, as a model to delineate the immediate signaling events which follow interaction of Epo with its receptor.

Outcome after free flap reconstruction of the heel

We reviewed six free flap reconstructions of the weight-bearing surface of the heel. Patients were seen for clinical evaluation at a mean follow-up of 4.7 years (range 2.7-6.0 years). Functional results using a modified Boston Children's Hospital Ankle Score were 33% excellent, 33% good, 17% fair, and 17% poor. The excellent functional results were related to the absence of chronic draining flap ulcers. All flaps lacked protective sensation by Semmes-Weinstein monofilament testing. Weightbearing plantar pressures in the flaps were elevated in all patients. Sequential radiographs from the time of flap coverage revealed the development of a bony protuberance (stalactite) projecting from the undersurface of the calcaneus in all patients with injuries to the plantar cortex of the calcaneus. In patients with flap ulceration, these stalactites projected into the ulcer at the site of maximum plantar pressure. A combination of loss of plantar calcaneal integrity, elevated pressure concentrations, and flap insensitivity appear causally related to the development of heel free flap ulceration and outcome.

Extended mortality follow-up among men and women in a U.S. furniture workers union

The addition of 5 years of follow-up and over 411,000 person-years of observation to a cohort of 34,081 men and women employed in U.S. furniture and other related industries allowed the investigation of mortality patterns among women and minority races in addition to white men. A significant excess of pleural mesotheliomas occurred among white men (standardized mortality ratio [SMR] = 3.7, 95% confidence interval [CI] = 1.2-8.7) but could not be linked to a particular type of furniture manufacturing. SMRs for myeloid leukemia and chronic nephritis were elevated among white men employed in the wood furniture industry but were not statistically significant. Males in the black/other race categories in wood furniture plants showed nonsignificant mortality excesses for infectious diseases and cancers of the prostate and colon and rectum. Among white women employed in wood furniture plants, mortality was elevated for cancers of the pancreas and lung during the most recent follow-up period. In metal furniture plants, mortality was raised among men in both race groups for kidney cancer (black/other SMR = 8.0, 95% CI = 1.6-23.2; white SMR = 2.1, 95% CI = 0.4-6.2) and diabetes mellitus (black/other SMR = 2.2, 95% CI = 0.6-5.6; white SMR = 1.8, 95% CI = 0.7-3.9). Stomach cancer mortality was significantly elevated (SMR = 3.3, 95% CI = 1.3-6.8) among white men in metal furniture plants and was of the same magnitude over both the previous and the most recent follow-up periods. Among those working with textiles, SMRs were significantly elevated for leukemia (SMR = 6.1, 95% CI = 1.2-7.8) and cancers of the colon and rectum (SMR = 3.2, 95% CI = 1.3-4.5) for white women. Lung cancer mortality was increased for white men and women in textile operations, but SMRs were not statistically significant. SMRs for a number of other causes of death that were elevated at the end of the earlier follow-up period were not increased during the new follow-up period.

The Maine Women's Health Study: I. Outcomes of hysterectomy

OBJECTIVE

To assess the effect of hysterectomy for nonmalignant conditions on symptoms and quality of life and to identify adverse effects 1 year after surgery.

METHODS

The Maine Women's Health Study was a prospective cohort study of 418 women ages 25-50 years undergoing hysterectomy for any nonmalignant condition. Patients recruited from the practices of 63 physicians performing hysterectomy throughout Maine were interviewed at the time of surgery and 3, 6, and 12 months later. Clinical and hospitalization data were obtained from physician reports and from a statewide hospital discharge data base. The primary outcomes of interest were symptom relief, changes in quality of life, and the development of new symptoms or problems during the year following surgery.

RESULTS

The most frequent indications for hysterectomy were leiomyomas (35%), abnormal bleeding (22%), and chronic pelvic pain (18%). For these indications, hysterectomy resulted in marked improvements in a range of symptoms, including pelvic pain, urinary symptoms, fatigue, psychological symptoms, and sexual dysfunction. Significant improvements in scores for indices of mental health, general health, and activity were evident at 6 months and sustained at 1 year. New problems after hysterectomy (measured in those free of the symptom preoperatively) included hot flashes (13%), weight gain (12%), depression (8%), and lack of interest in sex (7%).

CONCLUSIONS

Hysterectomy is highly effective for relief of symptoms associated with common nonmalignant gynecologic conditions. Symptom relief following hysterectomy is associated with a marked improvement in quality of life. New problems are reported after hysterectomy by a limited number of women.

The Maine Women's Health Study: II. Outcomes of nonsurgical management of leiomyomas, abnormal bleeding, and chronic pelvic pain

OBJECTIVE

To assess the effect of nonsurgical management of leiomyomas, abnormal uterine bleeding, and chronic pelvic pain on symptoms and quality of life.

METHODS

We performed a prospective cohort study of women receiving nonsurgical management (n = 380) or hysterectomy (n = 311) for leiomyomas, abnormal uterine bleeding, or chronic pelvic pain. Patients recruited from the practices of 63 physicians throughout Maine were interviewed at the outset of treatment and 3, 6, and 12 months later. The principal outcome measures were frequency and severity of physical and psychological symptoms, and quality of life as measured by validated indices of mental and general health and physical activity.

RESULTS

Medical therapy for abnormal bleeding and chronic pelvic pain produced significant improvements in symptoms and quality of life. However, almost one-quarter of patients initially treated nonsurgically subsequently underwent hysterectomy; of patients continuing nonsurgical therapy, 25% with abnormal bleeding and 50% with chronic pelvic pain reported substantial levels of symptoms after 1 year. There were no significant changes in symptoms and quality of life in patients treated nonsurgically for leiomyomas. New problems including tiredness, hot flashes, weight gain, and depression developed in 10% or less of women who did not report these symptoms preoperatively. A logistic regression analysis controlling for age, reproductive history, and severity of symptoms showed that hysterectomy was the factor most highly correlated with a positive outcome at 1 year for all three conditions.

CONCLUSIONS

Many women with leiomyomas, abnormal bleeding, and chronic pelvic pain report improved symptoms over time with nonsurgical management. Hysterectomy remains an important alternative when conservative treatment fails.

Efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine in elderly nursing home subjects during an influenza outbreak

OBJECTIVE

To compare the efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine with the commercially available influenza hemagglutinin-subunit vaccine in preventing influenza in older adults living in a nursing home.

DESIGN

A prospective, randomized, double-blind vaccine trial with 5 months of follow-up after vaccination.

SETTING

Fourteen Wisconsin nursing homes.

PARTICIPANTS

Nursing home residents at least 65 years old who were able to give informed consent and were free of malignancy and not receiving immunosuppressive therapy.

INTERVENTIONS

Participants received, by intramuscular injection, 0.5 mL of a trivalent influenza vaccine containing 15 micrograms each of A/Leningrad/360/86 (H3N2), A/Taiwan/1/86 (H1N1), and B/Ann Arbor/1/86 (HA) or 0.5 mL of an influenza vaccine containing the same antigens conjugated to diphtheria toxoid (HA-D).

MEASUREMENTS

Blood was obtained pre- and 1 month post-vaccination to assess for any vaccine-induced antibody titer change. Clinical surveillance for respiratory illness was performed twice weekly for 5 months. A record was kept of all signs and symptoms of new respiratory illness, and a viral culture and acute and convalescent sera were obtained.

RESULTS

204 participants received HA and 204 received HA-D. Both groups had similar baseline antibody levels to all influenza antigens. HA-D recipients seroconverted more frequently based on serum neutralizing activity (P < 0.05), had a greater increase in geometric mean titer (GMT), and sustained the increase in antibody titer longer than HA recipients. Vaccine hemagglutinin recall was greater in a subset of HA-D recipients as measured by lymphocyte proliferative assays (P < 0.05). During an outbreak of influenza A (H3N2 A/Shanghai/11/87-like and A/Victoria/7/87-like), fewer HA-D (29/195) than HA (43/204) recipients had laboratory-confirmed infection (P = 0.053), and, of these, fewer HA-D-treated subjects had lower respiratory tract involvement (5/29 HA-D and 17/43 HA) (P = 0.022).

CONCLUSIONS

HA-D was more immunogenic in institutionalized elderly recipients and produced greater protection from influenza infection. Superior protection may be due to HA-D's ability to stimulate and recruit antigen-presenting cells, thus enabling the recipient to achieve and maintain functional antibody titers.

Flexoelectric effects in model and native membranes containing ion channels

An experimental study of flexoelectricity in model membranes containing ion pores and native membranes containing ion channels has been undertaken with the objective of determining the relationship, if any, between flexoelectricity and ion transport. Model membrane patches containing ion pores induced by a blue-green algal toxin, microcystin-LR, and locust muscle membrane patches containing potassium channels were studied using patch-clamp techniques. A correspondence was established between the presence of open channels and pores and the amplitude of the 1st harmonic of the total membrane current when the membranes or patches were subjected to pressure oscillations. The 2nd harmonic of the membrane current provided a measure of the amplitude of a membrane curvature induced by pressure, thus making it possible to determine the membrane flexoelectric coefficient. This study shows that flexoelectricity could be an effective driving force for ion transport through membrane pores and channels, thus further highlighting the possible biological significance of this mechano-electric phenomenon.

Interrelationships between victimization experiences and women's alcohol use

The interrelationships between experiences of childhood victimization and the development of women's alcohol-related problems are explored. Two different forms of childhood victimization are examined: (1) parent-to-child violence and (2) childhood sexual abuse (familial and nonfamilial). Data were collected from 472 women between the ages of 18 and 45 during in-depth interviews. Women were grouped to allow for the following two sets of comparisons: comparison 1: alcoholics in alcoholism treatment (n = 98), drinking drivers (n = 100) and a household sample (without alcohol problems) (n = 82); comparison 2: women with alcohol problems in treatment (n = 178), women without alcohol problems in treatment (n = 92) and a household sample (n = 82). High rates of childhood victimization for women with alcohol problems suggest that there is a link between victimization and the development, specifically, of women's alcohol problems. The strength of the interrelationships between childhood victimization and the development of women's alcohol problems when holding the treatment condition constant is of particular interest in this study. The rates of childhood victimization were significantly greater for women with alcohol problems in treatment as compared to women without alcohol problems in treatment. Thus, even when holding the treatment condition and family background variables constant, childhood victimization has a specific connection to the development of women's alcohol problems. These findings remained significant even when controlling for demographic and family background differences, including parental alcohol problems.

Visual fields with protective eyewear

Sports-related eye injuries are quite common, yet the number of athletes who utilize protective eyewear is extremely low. The purpose of this study was to determine if there is a significant visual field loss associated with wearing eye protection. One of the authors was subjected to standard kinetic visual field testing with and without eye goggles. No significant difference was revealed. Physicians, physical therapists, and trainers should promote the use of protective eyewear and reassure athletes that they will not lose visual field.

Recent incidence trends for breast cancer in women and the relevance of early detection: an update

The incidence of breast cancer in women has been rising dramatically in the United States since 1982, based on data collected by the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. An additional three years of incidence and mortality data are included in this update of the earlier analyses; however, the focus of this report remains on examining the steeply increasing incidence trend between 1982 and 1986. Over this period, incidence rates for in situ and localized invasive tumors increased among women age 50 and older, while rates for regional and distant tumors remained stable. The incidence of localized tumors less than 1.0, 1.0 to 1.9, and 2.0 to 2.9 cm in size increased more rapidly than that of tumors 3.0 cm and greater among women over age 50. Survival rates also improved among cases diagnosed over this time period. These descriptive data suggest that early detection may be playing a role in the recent increase in the incidence of breast cancer in women, although other factors cannot be ruled out. Conclusions regarding improved cancer control await confirmation by reduced breast cancer mortality.