Paul K Mills

University of California, San Francisco, San Francisco, California, United States

Are you Paul K Mills?

Claim your profile

Publications (25)60.53 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to measure suicide risk in cancer patients and compare it with the general population. Suicide rates were based on 1,168 suicides in 1,123,528 cancer patients in California from 1997-2006 and were studied by race/ethnicity, sex, site, stage, and marital status. Suicide in cancer patients is 2.3 times the general population with 81% in the non-Hispanic Whites, and half within the first 2 years post diagnosis. In men, it rapidly increases by age to a high plateau in the early forties. Metastatic cancers and those of the prostate, lung and bronchus, pancreas, stomach, esophagus, and oral cavity in men and breast in women were associated with significantly higher risk. Cancer patients are at higher risk of suicide and should be specifically targeted for preventive efforts post diagnosis.
    Archives of suicide research: official journal of the International Academy for Suicide Research 10/2012; 16(4):324-33.
  • Richard C Yang, Paul K Mills
    [Show abstract] [Hide abstract]
    ABSTRACT: When the Vietnam War ended in 1975, pro-US Laotians (including Lao, Mien, Khmu) were displaced and became refugees in their own native country. Thousands fled to refugee camps in nearby Thailand and were eventually relocated to several Western countries, including the US. A listing of 1,195 Laotian cancer cases were extracted from the California Cancer Registry for diagnosis years 1988-2006. Cancer cases with birthplace coded as "Laos" were included. Proportionate incidence ratios (PIRs) and associated 95% confidence intervals (CI) were calculated for 17 selected cancer sites. The total population of California (all race/ethnic groups combined) was used as the reference. Proportional occurrence of cancers varied by genders and by cancer sites. Laotians in California experienced statistically significantly elevated risks for cancer of the nasopharynx (PIR = 14.8; 95% CI = 10.5-20.1), liver (PIR = 12.6; 95% CI = 10.8-14.6), stomach (PIR = 3.1; 95% CI = 2.4-4.0), cervix (PIR = 1.9; 95% CI = 1.5-2.3), pancreas (PIR = 2.1; 95% CI = 1.5-2.8), oral cavity (PIR = 1.8; 95% CI = 1.4-2.3), lung and bronchus (PIR = 1.4; 95% CI = 1.2-1.7). As found for other Asian subgroups, Laotians, too, have statistically significantly reduced risks for colorectal (PIR = 0.8; 95% CI = 0.6-0.9), colon (PIR = 0.7; 95% CI 0.5-0.9), breast (PIR 0.7; 95% CI = 0.5-0.8), and prostate (PIR = 0.1; 95% CI = 0.0-0.2) cancers. The increased risk found for mostly non-Western types of cancers have implications for culturally responsive cancer control and intervention activities targeting the Laotian population.
    Cancer Causes and Control 04/2009; 20(6):1011-6. · 3.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: From mid-1980s to early 1990s, there were several studies evaluating a condition known as "nocturnal sudden death syndrome" among the healthy, young Hmong (immigrants from Laos) individuals who mysteriously died from unknown causes during the night. To date, very little has been reported on the mortality patterns in the Hmong. The purpose of the present study is to examine causes of death (COD) and compare age-adjusted mortality rates (AAMR) in the Hmong with those of non-Hispanic white (NHW) population in California, which may yield useful data for health prevention and planning purposes. This study was based on 2,744 Hmong deaths occurred in California from 1988 to 2002. To calculate AAMR, Hmong population at risk of dying was derived by interpolating Hmong population counts from the 1990 and 2000 decennial censuses. For comparison, AAMR were calculated for both Hmong and NHW, and the statistical test, incidence rate ratio, was used to examine differences in relative mortality risk of each major COD between Hmong and NHW. AAMR are highest in neoplasm (184.0/100,000), circulatory (277.9/100,000) and respiratory (100.0/100,000) diseases for both Hmong and NHW. The AAMR for all COD during the entire study time period was 879.5/100,000 in males and 736.0/100,000 in females. AAMR for all other COD range from 4.9/100,000 to 67.2/100,000. Hmong experienced 1.3-1.9 times higher mortality rates for certain COD, compared to NHW. The interesting findings of this study are the differences in AAMR observed for lower ranking COD between Hmong and NHW. Hmong were found to be experiencing 1.3-1.9 times higher mortality rates for injuries and poisonings, digestive diseases, prenatal conditions, ENMID (endocrine, nutritional, metabolic, immunity disorders), infections and parasitic illnesses, and congenital anomalies when compared to NHW. However, while Hmong women were found to have statistically significantly higher mortality risk for injuries and poisonings (P-value < 0.05), ENMID (P-value < 0.05), and infections and parasitic ailments (P-value < 0.05) when compare to NHW women, Hmong men were observed to be at statistically significantly higher mortality risk for just infections and parasitic diseases (P-value < 0.05) when compared to NHW men.
    Journal of Immigrant and Minority Health 03/2009; 12(5):754-60. · 1.16 Impact Factor
  • Source
    Paul K Mills, Jennifer Dodge, Richard Yang
    [Show abstract] [Hide abstract]
    ABSTRACT: Studies of cancer among farm workers are difficult to conduct and interpret given the unique nature of this occupational group. The transitory nature of the work, high levels of poverty, and lack of legal documentation make epidemiologic studies difficult to accomplish. Nevertheless, this workforce in the United States, which numbers as much as 3 million persons, is a high risk population due to exposures to numerous toxic substances, including excessive sunlight, heat, dangerous machinery, fumes, fertilizers, dust, and pesticides. We summarize characteristics of farm workers (i.e., demographics, health care) from the National Agricultural Workers Survey (NAWS) and the California Agricultural Workers Survey (CAWS) and present findings from a series of studies conducted among farm workers in California. The epidemiology literature was reviewed and methods for a unique farm worker union-based epidemiologic study are presented. Farm workers in California and the rest of the United States, many of whom are seasonal and migrant workers are at elevated risk for numerous forms of cancer compared to the general population and specific pesticides may be associated with this altered risk. Elevated risks have been found for lymphomas and prostate, brain, leukemia, cervix, and stomach cancers.
    Journal of Agromedicine 02/2009; 14(2):185-91. · 0.72 Impact Factor
  • Richard C Yang, Paul K Mills
    [Show abstract] [Hide abstract]
    ABSTRACT: As Hmong adapt to life in Fresno, California, their dietary and lifestyle patterns are examined. Data on tobacco and alcohol use, dietary practices, and socio-demographic variables were collected from a convenience sample, stratified by age and sex. The 248 participants were interviewed. Descriptive analyses reveal that more than 63% of Hmong adults were either overweight or obese. Only 57% could speak English fluently, and 71% were economically impoverished. Hmong do not consume tobacco and alcoholic products excessively. Rice, chicken, beef, and eggs were the most frequently identified food items. Fruits and vegetables were also identified. Low alcohol and tobacco consumption may offer Hmong some protection against certain diseases. However, low socioeconomic status and rapid urbanization may have resulted in a shift from a high-energy expenditure lifestyle and high fiber diets to a sedentary lifestyle with high saturated fat food diets, which may be detrimental to the health of many Hmong.
    Journal of Health Care for the Poor and Underserved 12/2008; 19(4):1258-69. · 1.10 Impact Factor
  • Source
    Paul K Mills
    Environmental Research 10/2007; 105(2):287-288. · 3.24 Impact Factor
  • Paul K Mills, Richard C Yang
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous studies have indicated that farm workers may be at increased risk of gastric cancer. Meta-analyses, ecological, case-control, and cohort studies suggest that some aspects of the agricultural environment may be implicated in the elevated risk. Hispanic farm workers in California are exposed to a multitude of potentially toxic substances in the work site, including excessive sunlight, fertilizers, diesel fumes, and pesticides. A previous analysis of a cohort of California farm workers who had been members of a farm labor union, the United Farm Workers of America (UFW) found a proportionate cancer incidence ratio for stomach cancer of 1.69 when using the California Hispanic population as the standard. The aim of the current study was to further evaluate associations between gastric cancer and the types of crops and commodities UFW members cultivate and the associated pesticide use as recorded by the California Department of Pesticide Regulation (DPR). We conducted a nested case-control study of gastric cancer embedded in the UFW cohort and identified 100 cases of newly diagnosed gastric cancer between 1988 and 2003. We identified 210 control participants matched on age, gender, ethnicity, and who were known to be alive and resident in California up to the date of the cases' diagnosis. Both stratified analyses and unconditional logistic regression were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Work in the citrus industry was associated with increased gastric cancer (OR=2.88; 95% CI=1.02-8.12) although no other specific crops or commodities were associated with this disease. Working in areas with high use of the phenoxyacetic acid herbicide 2,4-D was associated with gastric cancer (OR=1.85; 95% CI=1.05-3.25); use of the organochlorine insecticide chlordane was also associated with the disease (OR=2.96; 95% CI=1.48-5.94). Gastric cancer was associated with use of the acaricide propargite and the herbicide triflurin (OR=2.86; 95% CI=1.56-5.23 and 1.69, 95% CI=0.99-2.89, respectively). Gastric cancer in California Hispanic farm workers is associated with work in the citrus fruit industry and among those who work in fields treated with 2,4-D, chlordane, propargite, and trifluin. These findings may have larger public health implications especially in those areas of the country where these pesticides are heavily used and where they may be found in the ambient atmosphere.
    Environmental Research 07/2007; 104(2):282-9. · 3.24 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although epidemiologic studies have identified elevated cancer risk in farmworkers for some cancer types, little is known about cancer survival in this population. To determine if cancer survival differs between a Hispanic farmworker population and the general Hispanic population in California. Hispanic United Farm Workers of America union members and California Hispanics diagnosed from 1988 to 2001 with a first primary cancer were identified from the California Cancer Registry. Kaplan-Meier observed 5-year cause-specific survival rates were calculated, and log-rank tests assessed population differences. Cox proportional hazards models for the most common cancers provided age-, stage-, and year of diagnosis-adjusted hazard ratios. Observed 5-year cancer-specific survival rates were lower for Hispanic United Farm Workers of America men compared to California Hispanic men for all cancer sites combined (53.7% vs 57.7%, respectively) and colorectal cancer (48.1% vs 60.6%, respectively) and higher for non-Hodgkin's lymphoma (86.7% vs 57.6%, respectively). Only non-Hodgkin's lymphoma survival differences remained significant (P = .021) after adjusting for age and stage at diagnosis. No statistically significant survival differences were detected between United Farm Workers of America and California Hispanic women. Although survival was generally similar between United Farm Workers of America members and California Hispanics, lower crude survival among United Farm Workers of America men for all sites combined and colorectal cancer warrants public health measures to address barriers to cancer screening in California's Hispanic farm-working populations. Histology-specific analyses with larger sample sizes are required before reaching conclusions on non-Hodgkin's lymphoma survival differences.
    The Journal of Rural Health 02/2007; 23(1):33-41. · 1.44 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To further investigate mortality among farm workers, a proportionate mortality ratio (PMR) analysis was conducted among the membership of the United Farm Workers of America (UFW), a farm worker labor union, for the years 1973-2000 in the state of California. This report compares proportionate mortality for 118 causes of death in the UFW and the general United States population, adjusting for age, sex, race and calendar year of death. In addition, an exploratory analysis was conducted comparing deaths in the UFW to deaths in the California Hispanic population. A roster of members of the UFW was compared to the death certificate master files of the state of California for the years 1973 to 2000. Matches were detected using automated techniques and visual review. PMR and associated confidence intervals were calculated using the National Institute for Occupational Safety and Health Life Table Analysis System using deaths in the U.S. as the standard. A similar analysis was conducted limiting attention to the time period 1988-2000 and using deaths in the California Hispanic population as the standard. There were a total of 139,662 members of the union included in the linkage that yielded 3,977 deaths in the time period 1973-2000. Proportionate mortality in the farm workers was significantly elevated for respiratory tuberculosis, malignant neoplasms of the stomach, biliary passages, liver and gallbladder, and uterine cervix, diabetes mellitus, cerebrovascular disease, cirrhosis of the liver, and "other diseases of the digestive system." Transportation injuries including motor vehicles deaths, deaths from machine injuries, unintentional poisonings and assault and homicide were significantly elevated as well. Farm workers were at significantly lower risk of death from HIV-related disease, malignant neoplasms of the esophagus, intestine, pancreas, lung, urinary bladder, melanoma, and brain, all cancer deaths, "other diseases of the nervous system," ischemic heart disease, conductive disorder, "other diseases of the heart," emphysema, "other respiratory diseases," and symptoms and ill-defined conditions. These results were similar when using California Hispanic deaths as the standard for the years 1988-2000. There was still excess proportionate mortality from tuberculosis, cerebrovascular disease and unintentional injuries among the UFW members and lowered mortality from HIV related deaths, all cancer deaths combined and diseases of the heart. These results include some unique findings in regard to both excess and deficits of mortality that may be explained by the Hispanic ethnicity and recent immigration of the cohort.
    Journal of Agromedicine 02/2006; 11(1):39-48. · 0.72 Impact Factor
  • Paul K Mills, Richard Yang
    [Show abstract] [Hide abstract]
    ABSTRACT: An evaluation of pesticide use data and breast cancer incidence rates in California Hispanic females was conducted via a regression analysis. The analysis used 1988-2000 data from the California Cancer Registry, the population-based cancer registry that monitors cancer incidence and mortality in California. It also used pesticide use data from 1970-1988 from the California Department of Pesticide Regulation. California is the leading agricultural state in the United States, and more than a quarter of all pesticides in the United States are applied there. Hispanic (Latina) females are commonly employed in agricultural operations. The authors performed regression analysis of county-level specific pesticide use data (pounds of active ingredients applied) for two classes of pesticides, organochlorines and triazine herbicides, against the breast cancer incidence rates among Latinas, controlling for age, socioeconomic status, and fertility rates, using negative binomial regression models. A total of 23,513 Latinas were diagnosed with breast cancer in California during the years 1988-1999. Risk of breast cancer was positively and significantly associated with age and socioeconomic status, and inversely and significantly associated with fertility levels. With respect to pesticides, breast cancer was positively associated with pounds of the organochlorines methoxychlor (adjusted incidence rate ratio [IRR] for highest quartile = 1.18; confidence interval [CI] = 1.03-1.35) and toxaphene (IRR = 1.16; CI = 1.01-1.34). No significant associations were found for the triazine herbicides atrazine and simazine.
    Journal of environmental health 01/2006; 68(6):15-22; quiz 43-4. · 1.01 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The Hmong represent a unique new Southeast Asian immigrant group to the U.S. Approximately 169,000 Hmong reside in the U.S., primarily in California, Minnesota, and Wisconsin. Previous studies of cancer in this population have indicated that Hmong experience an elevated risk of gastric, hepatic, cervical, and nasopharyngeal cancers and experience a reduced risk of breast, prostate, lung, and colorectal cancers. Approximately 65,000 Hmong live in California, where there has been a population-based cancer registry since 1988, and the authors used these data to calculate age-adjusted cancer incidence rates and to examine disease stage and tumor grade at diagnosis. Changes in rates during the period studied also were evaluated. These rates and proportions were compared with rates among the non-Hispanic white (NHW) and Asian/Pacific Islander (API) populations of California. Between 1988 and 2000, a total of 749 Hmong in California were diagnosed with invasive cancer, and the age-adjusted rate of cancer for the Hmong was 284 per 100,000 population, compared with 362.6 and 478 per 100,000 in the API and NHW populations, respectively. The age-adjusted incidence rates of cancer in the Hmong were elevated for hepatic, gastric, cervical, and nasopharyngeal cancers and for leukemia and non-Hodgkin lymphoma (NHL). Rates were lower in the Hmong for colorectal, lung, breast, and prostate cancers. For gastric cancer and lung cancer, age-adjusted rates increased between 1988 and 2000 in the Hmong, although breast cancer incidence declined. Cervical cancer incidence increased, rates of NHL were declining, and rates for colorectal cancer remained steady between 1988 and 2000. The Hmong experienced later disease stage at diagnosis than other API and generally poorer grade of disease at diagnosis. Hmong experienced lower overall invasive cancer incidence rates than API or NHW populations in California. However, they experienced higher rates of hepatic, gastric, cervical, and nasopharyngeal cancers; and, for most types of cancer, they were diagnosed in a later disease stage.
    Cancer 01/2006; 104(12 Suppl):2969-74. · 5.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We sought to determine whether women with ovarian cancer have increased occupational exposure to triazine herbicides. A population-based case-control study of incident cases (n=256) and random digit-dialed control subjects (n=1122) was conducted. Participants were administered telephone interviews to obtain agricultural work history. These histories were used with the statewide pesticide usage database to calculate cumulative exposure estimates. The data were analyzed by stratified analysis and unconditional logistic regression techniques. The analysis of ever versus never occupational exposure to triazines demonstrated that cases were slightly but not significantly more likely to be exposed than control subjects (adjusted odds=1.34; 95% confidence interval=0.77-2.33). There was no evidence of a dose-response relationship between triazines and ovarian cancer (P=0.22). Considered with previous studies and animal laboratory data, the current evidence is not persuasive as to the presence or absence of an association between ovarian cancer and triazine exposure.
    Journal of Occupational and Environmental Medicine 12/2005; 47(11):1148-56. · 1.85 Impact Factor
  • Paul K Mills, Richard Yang, Deborah Riordan
    [Show abstract] [Hide abstract]
    ABSTRACT: Agricultural risk factors for lymphohematopoietic cancers (LHC) in Hispanic farm workers in California were examined in a nested case-control study embedded in a cohort of 139,000 ever members of a farm worker labor union in California. Crop and pesticide exposures were estimated by linking county/month and crop specific job history information from union records with California Department of Pesticide Regulation pesticide use reports during the 20-year period prior to cancer diagnosis. A total of 131 LHC diagnosed in California between 1988 and 2001 were included in the analysis. Analyses were conducted by gender and subtype of non-Hodgkins lymphoma (nodal, extra nodal) and by leukemia histology (lymphocytic, granulocytic). Odds ratios were calculated by stratification and by unconditional logistic regression. Risk for all LHC was elevated in workers cultivating vegetables (OR = 1.67, 95% CI = 1.12-2.48). Risk of leukemia was associated with exposure to the pesticides mancozeb (OR = 2.35, 95% CI = 1.12-4.95) and toxaphene (OR = 2.20, 95% CI = 1.04-4.65) while NHL risk was increased in association with 2,4-D (OR = 3.80, 95% CI=1.85-7.81). Risk of leukemia was particularly elevated among female workers and for granulocytic versus lymphocytic leukemia for several chemicals. No associations were noted for multiple myeloma. California farm workers employed where mancozeb and toxaphene were used had an increased risk of leukemia compared to farm workers employed elsewhere. Employment in farms using 2,4-D was associated with an increased risk of NHL.
    Cancer Causes and Control 10/2005; 16(7):823-30. · 3.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although previous studies document elevated nasopharyngeal cancer incidence in the American Hmong, a descriptive analysis is lacking. The present case-series aims to identify important features of head and neck cancers in the California Hmong, specifically nasopharyngeal cancer. We assessed incident head and neck cancers identified by the California Cancer Registry from 1988-2000 for incidence, mortality and descriptive comparisons between the Hmong, non-Hispanic Whites (NHW) and Asian/Pacific Islanders (API). Nasopharyngeal cancer was the most frequent Hmong cancer (39 of 51 cases) with incidence 23 times greater than in NHW. Nasopharyngeal cancer mortality rates for Hmong, NHW and API were 10.4, 0.2 and 1.7/100,000 respectively. Hmong were more likely to be diagnosed with remote tumors and less likely to receive treatment. A public health disparity clearly exists regarding nasopharyngeal cancer in the Hmong. Education on culturally appropriate healthcare and efforts to encourage diagnosis and treatment are necessary to reduce this disparity.
    Oral Oncology 08/2005; 41(6):596-601. · 2.70 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examined gastric adenocarcinoma incidence, mortality, and tumor characteristics in the Hmong population of California, 1988-2000. Many Hmong relocated to the United States at the conclusion of the Vietnam War. Resettlement difficulties encountered by Hmong have included socioeconomic and healthcare issues. Hmong are wary of Western medicine and would resort to it as the last option, which may delay the diagnosis and treatment of diseases such as cancer. Data from the California Cancer Registry were used to calculate incidence and mortality rates for Hmong, and were compared to these in Asian Pacific Islanders (API) and non-Hispanic whites (NHW). The population at risk was estimated through linear interpolation, using data from the 1990 and 2000 decennial censuses. Hmong experienced incidence and mortality rates of gastric adenocarcinoma several times higher than those of API and NHW. More than 97% of Hmong patients chose no treatment, compared to only 25.6% of API and 30.3% of NHW patients. Hmong were more likely to be diagnosed with cancer at later stages but at better histologic grades than API and NHW. Further investigations into Helicobacter pylori, Epstein-Barr virus, acid reflux, and dietary practices of Hmong living in the United States are needed before any firm conclusion can be made, as these risk factors may impact gastric cancer development. Hmong should also be encouraged to use traditional and Western medicines simultaneously, provided that traditional healthcare practices do not interfere with biomedicines.
    Gastric Cancer 02/2005; 8(2):117-23. · 3.99 Impact Factor
  • Paul K Mills, Richard Yang
    [Show abstract] [Hide abstract]
    ABSTRACT: In a registry-based case-control study of breast cancer in farm labor union members in California, 128 breast cancer (BC) cases newly diagnosed in 1988--2001 and 640 cancer-free controls were investigated. Stage and grade of disease at diagnosis were about the same as in the California Hispanic population. Risk of breast cancer was not associated with work with any specific crops or commodities except mushrooms, where the adjusted odds ratio (OR) was 6.00 (95% CI 2.01-18.0). Controlling for covariates, adjusted ORs (and 95% CIs) for breast cancer in quartiles of pesticide use were 1.00, 1.30 (0.73-2.30), 1.23 (0.67-2.27), and 1.41 (0.66-3.02). Chlordane, malathion, and 2,4-D were associated with increased risk. Risk associated with chemical use was stronger in younger women, those with early-onset breast cancer, and those diagnosed earlier (1988--1994).
    International journal of occupational and environmental health 01/2005; 11(2):123-31. · 1.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Risk of epithelial ovarian cancer (EOC) attendant to use of hormone replacement therapy (HRT) was evaluated in a population-based case-control study of newly diagnosed EOC cases (n=256) and randomly selected population controls (n=1122). Telephone interviews were conducted to obtain information on history of HRT and several other covariates. Multivariate adjusted odds ratio (OR) and 95% confidence intervals (CI) were derived from unconditional logistic regression. The OR for ever use of HRT was 1.39 (95% CI: 1.01-1.93) compared to never use. Long-term use (>10 years) increased risk (OR: 1.62, CI: 1.05-2.50) although the trend p-value for duration of use was of only borderline significance (p=0.08). The relationship was stronger in women without hysterectomy (OR: 1.66, 95% CI: 1.14-2.41) or tubal ligation (OR: 1.56, 95% CI: 1.08-2.26). In this study, use of HRT is associated with an increased risk of EOC.
    Cancer Detection and Prevention 01/2005; 29(2):124-32. · 2.52 Impact Factor
  • Source
    H A Young, P K Mills, D Riordan, R Cress
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine if a job exposure matrix (JEM) could be developed using the California Department of Pesticide Regulation Pesticide Usage Database in conjunction with crop, time, and county specific self reported work history and to determine if this was a feasible method to obtain exposure estimates to triazine herbicides. Agricultural work histories were gathered from women enrolled in a population based case-control study of ovarian cancer cases and random controls. The work histories were used in conjunction with the database to construct job exposure matrices which took into account weightings for job type, work location, and crop. Cumulative exposure estimates were determined for 98 study subjects. Mean exposure estimates were similar for cases and controls. The exposure estimates were robust and insensitive to varying job weight assumptions. The estimates from the original weights were highly correlated with those constructed using the conservative and maximum weights. Estimates from all three schemes produced similar multivariate age adjusted odds ratios comparing cases and controls. There was a high degree of agreement in categorised quartiles of exposure between the original and conservative, and original and maximum weights. The exposure estimate from the JEM provides a ranking of exposure within the study population that can be utilised as an "exposure score" with which to compare groups. Although it is not an absolute exposure measurement, it does offer a substantial advance over dichotomous categories based on self report of herbicide use, particularly when subjects are unlikely to recall specific names and dates of use of herbicides.
    Occupational and environmental medicine 12/2004; 61(11):945-51. · 3.64 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Perineal talc use has been suggested as a possible risk factor for ovarian cancer based on its structural similarity to asbestos, a known human carcinogen. A population-based epidemiologic case-control study of epithelial ovarian cancer (EOC) was conducted in 22 counties of Central California that comprise the reporting area for 2 regional cancer registries. Telephone interviews were conducted with 256 cases diagnosed in the years 2000-2001 and 1,122 controls frequency-matched on age and ethnicity. The interview obtained information on demographic factors, menstrual and reproductive experience, exogenous hormone use, surgical history and family history of cancer. Questions on perineal talc use included frequency of use, duration of use and specific years when talc was used. Multivariate-adjusted odds ratio (OR) and 95% confidence intervals (CI) were derived from unconditional logistic regression. The OR for ever use of talc was 1.37 (CI = 1.02-1.85) compared to never users. However, no dose response association was found. Tubal ligation (TL) modified the effect of talc on EOC such that women with TL had an OR of 0.88 (CI = 0.46-1.68) associated with perineal talc use, whereas women with no TL had an OR of 1.54 (CI = 1.10-2.16). Talc use and EOC risk was highest in women with serous invasive tumors (OR = 1.77; CI = 1.12-2.81). This study provides some support for the hypothesis that perineal talc use is associated with an increased risk of EOC.
    International Journal of Cancer 12/2004; 112(3):458-64. · 6.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate epithelial ovarian cancer (EOC) risk factors by level of invasiveness and histology. A population-based epidemiologic case-control study of EOC was conducted over a 2-year period (January 2000 to December 2001) in 22 counties of Central California that comprise the reporting area for two regional cancer registries. Telephone interviews were conducted with 256 cases and 1122 control frequencies matched on age and ethnicity. The interview obtained information on demographic factors as well as information pertinent to the respondent's menstrual and reproductive experience, use of exogenous hormones, surgical history, and family history of cancer. Adjusted odds ratios were calculated using stratification as well as Logistic regression methods. Analyses were completed by level of invasiveness and cell type. Strong protective associations were observed for use of oral contraceptives and parity. Risk increased with a family history of ovarian, but not breast cancer and age at first birth was positively associated with increased risk. Hormone replacement therapy was associated with increased risk only in long-term users. Many of the relationships were observed only in specific histologic subtypes of EOC. Risk of EOC is associated with several lifestyle and environmental exposures but the impact of these effects appears to be dependent upon level of invasiveness and histologic subtypes of EOC. However, the sample size available for analysis limits our statistical power and our ability to analyze data by histologic subtype, thus limiting interpretation of our results.
    Gynecologic Oncology 11/2004; 95(1):215-25. · 3.93 Impact Factor

Publication Stats

362 Citations
60.53 Total Impact Points

Institutions

  • 2006–2012
    • University of California, San Francisco
      • Division of General Internal Medicine
      San Francisco, California, United States
  • 2009
    • University of San Francisco
      Fresno, California, United States
  • 2004
    • California Department of Public Health
      California City, California, United States
  • 2003
    • CSU Mentor
      Long Beach, California, United States