Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity

Individual environmental contaminants have been associated with breast cancer; however, evaluations of multiple exposures simultaneously are limited. Herein, we evaluated associations between breast cancer summary stages and the Environmental Quality Index (EQI), which includes a range of environmental factors across five domains. The EQI (2000-2005) was linked to county-level age-standardized incidence rates (SIRs) obtained from the North Carolina Central Cancer Registry (2010-2014). Incidence rates and SIRs of total, in situ, localized, regional, and distant breast cancers were evaluated stratified by rural-urban status. In counties with poor environmental quality compared to those with good environmental quality, total breast cancer incidence was higher by 10.82 cases per 100,000 persons (95% CI 2.04, 19.60, p = 0.02). This association was most pronounced for localized breast cancer (β = 5.59, 95% CI 0.59, 10.58, p = 0.03). Higher incidence of early-stage disease (carcinoma in situ β = 5.25, 95% CI 2.34, 8.16, p = 0.00 and localized breast cancer β = 6.98, 95% CI 2.24, 11.73, p = 0.00) and total breast cancer (β = 11.44, 95% CI 3.01, 19.87, p = 0.01) occurred in counties with poor land quality, especially urban counties. Our analyses indicate significant associations between environmental quality and breast cancer incidence, which differ by breast cancer stage and urbanicity, identifying a critical need to assess cumulative environmental exposures in the context of cancer stage.

Abstract PR06: North Carolina environmental quality is associated with distant/metastatic breast cancer: Evidence for rural-urban disparities

Breast cancer is a complex and multifactorial disease, and there is increasing evidence of association between breast cancer incidence and environmental factors. This study sought to investigate the effects of cumulative environmental quality on aggressive breast cancer in North Carolina. We hypothesized that environmental quality plays a role in aggressive breast cancer incidence, and additionally that these effects vary by rural-urban context. The USEPA generates an environmental quality index (EQI), which contains county-level data on environmental quality across five domains—air, water, land, sociodemographic, and built. To address our hypothesis, we compared the odds of having distant/metastatic breast cancer versus ductal carcinoma in situ (DCIS) based on total and domain-specific EQI values, with cancer case information extracted from the North Carolina Central Cancer Registry (years 2009-2014) and based on staging criteria from the Surveillance, Epidemiology, and End Results Program (SEER). We used generalized estimating equation (GEE) models to generate odds ratios for having distant/metastatic breast cancer using DCIS patients as controls and quartiled EQI domain values, adjusting for individual age, BMI, and smoking status. We also stratified patients into rural-urban categories based on their county at diagnosis, representing more urbanized to more thinly populated areas. Each EQI domain is composed of several individual environmental factors, so we then investigated which of these individual factors were driving domain specific effects. Results show that there is an effect of environmental quality on distant/metastatic breast cancer. For example, patients residing in a county with the worst land environmental quality were 5% more likely to have distant/metastatic breast cancer than DCIS (OR 1.05, 95% CI 1.01-1.09, p=0.0063). This effect was stronger in more rural areas. Within the land domain, higher use of agricultural chemicals such as herbicides and insecticides had effects on increased distant/metastatic breast cancer incidence in more urban areas, whereas the number of animal facilities had a large effect in more rural areas. Additionally, patients residing in a county with the worst sociodemographic environmental quality were 6% more likely to have distant/metastatic breast cancer than DCIS (OR 1.06, 95% CI 1.02-1.09, p=0.0006), which was consistent across rural/urban areas. Within the sociodemographic domain, higher income and higher household value decreased odds of having distant/metastatic breast cancer regardless of whether the area was rural or urban. In conclusion, we have shown that cumulative environmental quality is associated with distant/metastatic breast cancer, and that these effects can differ by rural-urban area. This is relevant for further studies of environmental exposures associated with aggressive breast cancers.

This abstract is also being presented as Poster A07.

Citation Format: Larisa M. Gearhart-Serna, Kate Hoffman, Brittany A. Mills, Gayathri R. Devi. North Carolina environmental quality is associated with distant/metastatic breast cancer: Evidence for rural-urban disparities [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr PR06.

Do stressful events account for the link between socioeconomic status and mental health?

BACKGROUND

The purpose of this study was to prospectively examine the relationships between socioeconomic status (SES), demographic variables and mental health and to determine whether number of life stressors mediated these relationships.

METHODS

Wave 1 (2001-02) and 2 (2004-05) data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 34,459) were used in the current study. Controlling for wave 1 mental health, a mediation model was tested to determine the relative impact of socioeconomic and demographic variables (all measured at wave 1) on mental health 3 years later (wave 2). The number of life stressors experienced in the 12 months prior to wave 1, assessed at wave 1, was evaluated as the mediator.

RESULTS

Findings indicated that SES, age, race/ethnicity, gender and marital status independently predicted changes in mental health ratings at wave 2. In addition, the number of life stressors mediated the relation between socioeconomic and demographic variables and mental health. Exposure to life stressors helps to explain commonly reported socioeconomic and demographic disparities in mental health.

CONCLUSIONS

Findings may suggest that reducing exposure to stressors and/or improving coping with life stressors may both improve mental health and reduce health disparities.

Scanning electron microscopic appearance of chronic ulcerative colitis with and without dysplasia

This study was conducted to determine whether scanning electron microscopy of colonic mucosal biopsy specimens can help to detect dysplasia in patients with chronic ulcerative colitis. In the first phase of the study, using light microscopy as the standard for the diagnosis, the scanning electron microscopic appearance of specimens from patients with chronic ulcerative colitis and control patients was examined. Descriptive criteria were established to identify normal, atrophic, and dysplastic colonic mucosa. In the second phase, quantitative techniques were used to develop more objective criteria for the diagnosis of dysplasia in ulcerative colitis. Twenty-one coded colonic specimens from 11 patients were sequentially examined by scanning electron microscopy and by light microscopy. The three morphometric analyses performed on the surface epithelial cells were number of cells per unit area, number of microvilli per unit area, and percentage of microvilli with a normal width. The cell count and percentage of microvilli with a normal width were significantly reduced in the seven specimens with colonic dysplasia as compared with non-dysplastic tissues. Scanning electron microscopy may serve as an adjunct to light microscopy in the diagnosis of colonic dysplasia.

Angiodysplasia as a cause of upper gastrointestinal bleeding

Angiodysplasia of the stomach, the proximal part of the small intestine, or both was diagnosed in 30 patients by upper gastrointestinal (Gl) endoscopy over a 40-month period. This diagnosis represented 4% of 676 patients referred over the same time period for endoscopic examination of suspected upper Gl bleeding. Twenty-three patients (77%) had experienced at least one episode of overt bleeding (hematemesis or melena) prior to diagnosis. Multiple gastroduodenal angiodysplastic lesions were found in 19 (63%) of the patients, and additional colonic angiodysplasia was detected in six of 12 patients who also underwent colonoscopy. Renal insufficiency was significantly more prevalent in the patients with angiodysplasia than in a comparison group of similar age with upper Gl bleeding from other lesions (60% v 24%). We conclude that angiodysplasia, although uncommon, should be considered in the differential diagnosis of both occult and overt upper Gl bleeding. The lesion appears to be associated with renal insufficiency.

Nodular duodenitis. Pathologic and clinical characteristics in patients with end-stage renal disease

This prospective study evaluated the radiographic, endoscopic, histologic, and clinical characteristics of nodular duodenitis found in 17 of 50 (34%) patients with end-stage renal disease. By comparison, nodular duodenitis was noted in only 23 of 557 (4%) consecutive endoscopies in a general medical population. Endoscopic nodular duodenitis consisted of two or more nodules, 2.5-7.0 mm in diameter, with apical erythema, with or without tip erosions. Eight patients had nodules in the bulb only, eight had diffuse duodenal nodules, and a single patient had nodules only in the second portion of the duodenum. Single-contrast barium x-rays were sensitive in detecting the nodules only when they were 5 mm or greater in diameter. Some degree of inflammatory infiltrate was found in 14 of 17 (82%) of the patients with nodular duodenitis; 10 of 17 had a moderate to severe histologic grade compared to 3 of 18 (P = 0.015) patients with a normal endoscopic appearance to the duodenum. Several patients with endoscopic nodular duodenitis, in whom biopsies were taken both of the nodule and surrounding mucosa, were found to have a focal histologic lesion which consisted of villous blunting and thickening due to fibrosis and a chronic inflammatory infiltrate or lymphoid aggregate in the stroma. A higher incidence of peptic ulcers occurred in the nodular duodenitis group (3 of 17) compared to the remainder of the group (0 of 33) during a mean follow-up of 38 months (P = 0.03). Resolution of the nodules occurred in six patients following successful renal transplant (four patients) and following vagotomy and pyloroplasty (two patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclophosphamide-induced cardiomyopathy: a report of two cases and review of the English literature

Fatal cardiomyopathy developed in two patients receiving cyclophosphamide in preparation for bone marrow transplantation. Both patients had normal EKGs prior to receiving cyclophosphamide in total doses of 168 mg/kg (case 1) and 144 mg/kg (case 2) and subsequently developed loss of voltage and ST-T wave changes. One patient (case 1) died of CHF and hypotension while the other patient (case 2) developed tamponade. Prior to this report, the lowest total dose of cyclophosphamide reported to cause fatal cardiomyopathy was 180 mg/kg. In contrast to anthracycline congestive cardiomyopathy, the effects of cyclophosphamide appear to have an acute onset and do not appear to be the cumulative result of drug dosing. Postmortem examination in both patients revealed thickened left ventricles with intramyocardial hemorrhage.