Paul K Mills

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

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Publications (33)104.25 Total impact

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    ABSTRACT: Clinical diagnosis of severe asthma and chronic obstructive lung disease (COPD) remains a challenge and often flawed with lack of objective confirmation of airflow obstruction (AO). Misdiagnosis of asthma and COPD has been reported in stable disease, data are non-existent in frequent exacerbators. We investigated misdiagnosis and its predictors in frequent exacerbators. The cohort comprised of frequent severe exacerbators (requiring ≥2 emergency room (ER) visits or hospitalizations) of physician diagnosed (PD)-asthma and PD-COPD. All patients underwent a rigorous diagnostic algorithm over a follow-up period of 10 ± 6 months. Two board-certified pulmonologists ascertained final diagnosis. Patients with persistent absence of AO were identified to have misdiagnosis. Multivariate logistic regression analyses were used to identify predictors of misdiagnoses. Among 333 frequent exacerbators analyzed (171 patients with PD-asthma, 162 with PD-COPD, mean annual exacerbations 3.4 ± 2.8), 24 % of patients had a baseline post-bronchodilator spirometry. Misdiagnosis was found in 26 % (87 of 333) of patients. Another 12 % (41 of 333) of patients had obstructive lung diseases other than asthma and COPD. Independent risk factors for misdiagnosis were spirometry underutilization (PD-asthma: OR = 2.8, 95 % CI 1.16-6.78, p = 0.02 and PD-COPD: OR = 10.7, 95 % CI 2.05-56.27, p = 0.005) and pack years of smoking (PD-COPD: OR = 1.05, 95 % CI 1.01-1.11, p = 0.03). Objective confirmation of AO is essential in preventing misdiagnosis in frequent severe exacerbators of clinically diagnosed asthma and COPD, a third of whom have neither. Spirometry utilization is strongly associated with a reduced risk of misdiagnosis. Smoking is associated with increased risk of misdiagnosis in severe COPD, but not asthma.
    Beiträge zur Klinik der Tuberkulose 04/2015; 193(4). DOI:10.1007/s00408-015-9734-6 · 2.27 Impact Factor
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    ABSTRACT: Background Conflicting data exists on the effectiveness of integrated programs in reducing recurrent exacerbations and hospitalizations in patients with Asthma and chronic obstructive lung disease (COPD). We developed a pulmonologist-led Chronic Lung Disease Program (CLDP) for patients with Severe Asthma and COPD and analyzed its impact on healthcare utilization and predictors of its effectiveness. Methods CLDP elements included clinical evaluation, onsite pulmonary function testing, health education, and self-management action plan along with close scheduled and on-demand follow-up. Patients with >2 Asthma or COPD exacerbations requiring emergency room visit or hospitalization within the prior year were enrolled, and followed for respiratory related ER visits (RER) and hospitalizations (RHA) over the year (357±43 days) after CLDP interventions. Results A total of 106 patients were enrolled, and 104 patients were subject to analyses. During the year of follow-up after CLDP enrollment, there was a significant decrease in mean RER (0.56±1.48 versus 2.62±2.81, p<0.0001), mean RHA (0.39±0.08 versus 1.1±1.62, p<0.0001), and 30 day rehospitalizations (0.05±0.02 versus 0.28±0.07, p<0.0001). Reduction of healthcare utilization was strongly associated with GERD and sinusitis therapy, and was independent of pulmonary rehabilitation. Direct variable cost analyses estimated annual savings at $1.17 million. Multivariate logistic regression analysis revealed lack of spirometry utilization as an independent risk factor for severe exacerbations. Conclusions A Pulmonologist-led disease management program integrating key elements of care is cost effective and significantly decreases severe exacerbations. Integrated programs should be encouraged for care of frequent exacerbators of Asthma and COPD.
    Respiratory Medicine 09/2014; 108(12). DOI:10.1016/j.rmed.2014.09.010 · 3.09 Impact Factor
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    ABSTRACT: Several inflammation biomarkers have been implicated in the pathogenesis and prognosis of acute coronary syndromes (ACS). However, the prognostic role of the neutrophil-lymphocyte white cell interactive response to myocardial injury in predicting short and long-term mortality after ST elevation myocardial infarction (STEMI) remains poorly defined. We evaluated 250 consecutive STEMI patients presenting acutely for revascularization to our tertiary care center over one year. Patients with acute sepsis, trauma, recent surgery, autoimmune diseases, or underlying malignancy were excluded. Data gathered included demographics, clinical presentation, leukocyte markers, electrocardiograms, evaluations, therapy, major adverse cardiac events, and all-cause mortality. : RESULTS: Mean age was 62±15 years, 70.4% of subjects were males while majority (49.4%) were Caucasians. Mean duration of follow up was 571±291 days (Median=730 days). Univariate analysis of several inflammatory biomarkers including CRP, revealed White Cell Count (OR=1.09, p<0.001) and neutrophil to lymphocyte ratio [NLR] (OR=1.05, p=0.011) as predictors of short and long term mortality; but not mean neutrophil count (OR=1.04, p=0.055) or lymphocyte count alone (OR=0.96, p=0.551). Multivariate analysis using backward stepwise regression revealed Neutrophil/Lymphocyte Ratio [NLR] (OR=2.64, p=0.026), female gender (OR=5.35,P<0.001), cerebrovascular accident history (OR=3.36,P=0.023), low glomerular filtration rate (OR=0.98,P=0.012) and cardiac arrest on admission (OR=17.43,p<0.001) as robust independent predictors of long term mortality. NLR was divided into two sub-groups based on an optimal cut off value of 7.4. This provided the best discriminatory cut off point for predicting adverse mortality outcome. Both short term (≤ 30 days) and long term (≤ 2 years) mortality were best predicted with Kaplan Meier survival curve separation best stratified by a NLR cut off of 7.4. NLR based on an optimal cut off value of 7.4, was an excellent predictor of short and long-term survival in patients with revascularized STEMI and warrants larger scale multi-center prospective evaluation, as a prognostic indicator. NLR offers improved prognostic capacity when combined with conventional clinical scoring systems, such as the TIMI risk score.
    Cardiology journal 10/2013; 21(5). DOI:10.5603/CJ.a2013.0148 · 1.06 Impact Factor
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    Dee W West · Paul K Mills ·

    Journal of the National Cancer Institute 07/2013; 105(15). DOI:10.1093/jnci/djt196 · 12.58 Impact Factor
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    Journal of the American College of Cardiology 03/2013; 61(10):E97. DOI:10.1016/S0735-1097(13)60098-4 · 16.50 Impact Factor
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    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. DOI:10.1080/13811118.2013.722056
  • Abhishek Sawant · Paul K Mills · Hemant Dhingra ·
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    ABSTRACT: The creation and maintenance of vascular access for hemodialysis patients is responsible for a significant amount of morbidity and hospital expenses which continue to escalate with increasing population of ESRD patients. A retrospective review of patient charts were performed from 2008 to May 2011 at an academic tertiary care center who had a diagnosis of vascular access failure based on ICD 9 coding. Data regarding demographic information, length of stay (LOS), source of insurance, hospital expenses, and discharge status were obtained. Based on strict inclusion criteria we identified 172 total patients. The mean age among all patients was 60.53 ± 15.35 years and the majority of patients were Hispanic (n = 81). The Mean LOS was 5.30 ± 4.64 days. Mean hospital costs were 41,896 ± 20,318 US$. Patients admitted for tunneled dialysis placement had greater length of stay (p-value = 0.011) as did patients with hypertension (p-value = 0.030). Hospital expenses were significantly higher for patients admitted for arterio-venous fistula complications (55,456 ± 23,779 US$) compared with admissions for catheter or dialysis graft related complications (p-value = 0.004). Patients on Medicare had significantly lower length of stay (3.98 ± 3.32 days) compared with patients with Medicare/Medical (6.59 ± 5.69 days), p-value = 0.047. Inpatient management of vascular access failure is associated with increased length of stay, and significant hospital expenses. Timely referral to vascular access centers can prevent unnecessary hospitalizations and provide cost-saving benefits.
    Seminars in Dialysis 06/2012; 26(1). DOI:10.1111/j.1525-139X.2012.01083.x · 1.75 Impact Factor
  • Richard C Yang · Paul K Mills ·
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    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. DOI:10.1007/s10552-009-9325-z · 2.74 Impact Factor
  • Richard C Yang · Paul K Mills · Kiumarss Nasseri ·
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    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. DOI:10.1007/s10903-009-9230-2 · 1.16 Impact Factor
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    Paul K Mills · Jennifer Dodge · Richard Yang ·
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    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. DOI:10.1080/10599240902824034 · 0.91 Impact Factor
  • Richard C Yang · Paul K Mills ·
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    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. DOI:10.1353/hpu.0.0096 · 1.10 Impact Factor
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    Paul K Mills ·

    Environmental Research 10/2007; 105(2):287-288. DOI:10.1016/j.envres.2007.05.001 · 4.37 Impact Factor
  • Paul K Mills · Richard C Yang ·
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    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).
    Environmental Research 07/2007; 104(2):282-9. DOI:10.1016/j.envres.2006.11.008 · 4.37 Impact Factor
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    Jennifer L Dodge · Paul K Mills · Deborah G Riordan ·
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    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. DOI:10.1111/j.1748-0361.2006.00065.x · 1.45 Impact Factor
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    Kiumarss Nasseri · Paul K Mills · Mark Allan ·
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    ABSTRACT: International statistics suggest lower cancer incidence in the Middle East and Middle Eastern (ME) immigrants in Europe, Australia, and Canada, but little is known from the United States. This study compares cancer rates in ME population with other race/ethnic groups in California from 1988 through 2004. ME cases in California cancer registry were identified by surname and ME population was estimated from U.S. Census data. Cancer rates for ME countries was obtained from Globocan. The ME incidence rate ratios for all sites combined in male and female were 0.77 and 0.82, respectively and were statistically significant. ME rates were significantly lower for cancers of the colon, lung, skin melanoma, female breast and prostate, and were significantly higher for cancers of the stomach, liver, thyroid, leukemia, and male breast. Cancer incidence in ME population in California was 2.4 times higher than rates in home countries. Incidence trends in ME males remained fairly stable but in females shows a slight decline in recent years. Cancer incidence in ME population is lower than non-Hispanic white and non-Hispanic Black, but is higher than rates for Hispanics and Asians, and ME countries. Improved data quality, chronic infections, acculturation, and access to screening services are some of the factors responsible for the observed pattern.
    Asian Pacific journal of cancer prevention: APJCP 11/2006; 8(3):405-11. · 2.51 Impact Factor
  • Arti Parikh-Patel · Paul K Mills · Ratnali V Jain ·
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    ABSTRACT: Very little is known about cancer survival patterns among the growing South Asian community in the United States. Breast cancer survival patterns were evaluated among South Asians using California Cancer Registry data from 1988 to 1998, and breast cancer survival among South Asians was compared to non-Hispanic Whites and other Asian subgroups. The analysis included all female, invasive, histologically confirmed breast cancer cases diagnosed from 1988 to 1998. The outcome of interest was death due to breast cancer. The Kaplan-Meier method was used to calculate 5- and 10-year survival probabilities. South Asians were less likely to be diagnosed with early stage carcinomas relative to non-Hispanic Whites, Chinese and Japanese individuals. In unadjusted analyses, South Asians experienced poorer survival than non-Hispanic Whites at later survival times. The 5- and 10-year unadjusted survival probabilities for South Asians were 84% and 76%, respectively, compared to those for non-Hispanic Whites, which were 87% and 80%, respectively. There was no significant difference in survival between South Asians and non-Hispanic Whites after multivariate adjustment. These data suggest the need for targeted efforts to improve early stage diagnosis among South Asian women. Further research into the factors that influence survival among South Asians is also needed.
    Cancer Causes and Control 05/2006; 17(3):267-72. DOI:10.1007/s10552-005-0520-2 · 2.74 Impact Factor
  • Paul K Mills · James J Beaumont · Kiumarss Nasseri ·
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    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. DOI:10.1300/J096v11n01_05 · 0.91 Impact Factor
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    Richard C Yang · Paul K Mills · Jennifer L Dodge ·
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    ABSTRACT: In the United States, breast, cervical, colorectal and prostate cancer screening rates are low or non-existent in the Hmong population compared to non-Hispanic Whites. No Hmong adults report ever participating in prostate (male only) and colorectal cancer screening. US-born Hmong women, those living in the US 20 years, and those 39 years old are more likely to be screened for breast and cervical cancer than other women. The Hmong, in general, are a young population (median age = 34 years) with low socioeconomic status. As a function of these characteristics, 52% of Hmong women reported having their first child at 15-19 years old and continued to bear children until 40-54 years old. The combination of young age at first pregnancy and multiparity probably protects Hmong women from breast cancer but elevates cervical cancer risk.
    Asian Pacific journal of cancer prevention: APJCP 01/2006; 7(1):79-85. · 2.51 Impact Factor
  • Paul K Mills · Richard Yang ·
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    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. · 0.96 Impact Factor
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    Paul K Mills · Richard C Yang · Deborah Riordan ·
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    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 12/2005; 104(12 Suppl):2969-74. DOI:10.1002/cncr.21525 · 4.89 Impact Factor

Publication Stats

603 Citations
104.25 Total Impact Points


  • 2009-2015
    • University of California, San Francisco
      • • Division of General Internal Medicine
      • • Department of Medicine
      San Francisco, California, United States
    • University of San Francisco
      Fresno, California, United States
  • 2005-2012
    • California State University, Fresno
      Fresno, California, United States
    • Institute of Public Health
      Bengalūru, Karnataka, India
  • 2004
    • California Department of Public Health
      Richmond, California, United States
    • Trinity Washington University
      Washington, Washington, D.C., United States
  • 2003
    • CSU Mentor
      Long Beach, California, United States