Epidemiology and Health

Volume 22 (1); June 2000

Original Articles

The Menstrual, Reproductive, and Lactational Factors and the Risk of Breast Cancer in Korea: A Population Based Case-Control Study.: Myung Hee Shin, Jung Hyun Yang, Kuk Jin Choi, Yoon Ok Ahn; Korean J Epidemiol. 2000;22(1):68-68.

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This study was conducted to assess the risk of breast cancer by menstrual, reproductive, and lactational factors in Korean women. A total of 210 women living in Seoul aged 30 to 60 with a first diagnosis of breast cancer from 2 teaching hospitals in Seoul, and 249 control subjects, randomly selected from the female pensioners of Korean Medical Insurance Company living in Seoul were interviewed. There was a increasing risk with the decrease of age at menarche, and the adjusted odds ratio(OR) of early menarche(age 14 years or less compared with over 17 years) was 1.61(95% Confidence Interval [CI]: 0.95-2.74). The longer the interval between menarche and regular menstruation, the less risk of breast cancer(OR=0.31, 95% CI: 0.16-0.60). The effect of these menarche factors were more prominent among premenopausal women. The adjusted OR for the second category(25-29 years old) of the age at first pregnancy and the age at the first full term pregnancy, compared to the reference category( 24 years old), were 0.52(95% CI: 0.30-0.92) and 0.58(95% CI: 0.32-1.06), respectively. The late age at the last full term pregnancy had significant protective effect (OR=0.29, 95% CI: 0.10-0.88), and the age itself was important rather than the interval between the first and last full term pregnancy. Factors related to breast feeding(BF) had protective effect consistently. Among parous women, in referent to no BF, women with 1 year of BF had adjusted OR of 0.34(95% CI: 0.17-0.68), while those with 1-3 years of BF had 0.35(95% CI: 0.18-0.67), 3-5 years had 0.29(95% CI: 0.12-0.74), and more than 5 years had 0.06(95% CI: 0.02-0.17). Age at menarche with regular cycle have stronger effect on especially pre-menopausal breast cancer among Korean women. Recent increase in breast cancer incidence in Korea would be explained by delayed age at first pregnancy or delivery, earlier age at menarche and last delivery, and decrease in brest feeding.; Summary

The Role of Genetic Polymorphism of Cytochrome P450 2E1 in Bladder Cancer in Korea.: Jiyeob Choi, Seungjoon Lee, Kyoungmu Lee, Inmi Choi, Youngju Lee, Hyungjune Im, Sang Yun Lee, Kijung Yoon, Sooung Kim, Moonsoo Park, Hanyong Choi, Whang Choi, Keunyoung Yoo, Soohun Cho, Daehee Kang; Korean J Epidemiol. 2000;22(1):59-67.

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Although the association of genetic polymorphisms in glutathione S-transferase(GST) and N-acetyltransferase(NAT) with bladder cancer has been reported, limited numbers of studies have been indicated the association of CYP2E1 with bladder cancer, particularly in Asian population. A hospital based case-control study was conducted in South Korean, consisting of 232 histologically confirmed prevalent bladder cancer cases and 165 controls to evaluate the association between genetic polymorphisms of CYP2E1(RsaI) and development of bladder cancer. The frequency of CYP2E1(RsaI) c1/c1 genotype in bladder cancer cases was higher than in controls; 114 of 201(56.7%) vs. 62 of 146(42.5%). Men with CYP2E1(RsaI) c1/c1 genotype had increased risk of development of bladder cancer compared to men with at least one c2 allele(OR=1.7, 95% CI=1.1-2.7). The bladder cancer risk increased as the number of c1 allele increased(p for trend=0.005). The risk increased as the amount of smoking increased(p for trend=0.009). When data were analyzed for the interaction between smoking and CYP2E1 genetic polymorphisms, smokers with c1/c1 genotype have 2.5 greater risk in development of bladder cancer(95% CI=1.0-6.2) compared to nonsmokers with c2 allele(p for interaction=0.008). Our findings suggest that the interaction between genetic polymorphisms of CYP 2E1 (RsaI, c1/c1) and smoking may play an important role for development of bladder cancer among Koreans.; Summary

Glutathione S-transferase(GST) M1 and T1 Genetic Polymorphism in Benign Breast Disorders of Korean Women.: Sue Kyung Park, Mina Ha, Sook Un Kim, Daehee Kang, Keun Young Yoo; Korean J Epidemiol. 2000;22(1):52-58.

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Abstract PDF: Abstract
PURPOSE
A hospital-based case-control study was conducted to evaluate the role of glutathione-S-transferase(GST)M1 and GSTT1 genetic polymorphism for developing benign breast disorders(fibrocystic diseases and fibroadenoma) in Korea. MATERIALS AND METHODS: Histologically confirmed incident cases of benign breast disorder(n=56) were selected from inpatients at the Department of General Surgery, Seoul National University Hospital since 1994. Women with free of self-reporting past history of any malignancies were regarded as controls who were selected from the inpatients at the same department at three hospitals during 1994 to 1998(n=180). Information on life-styles including reproductive factors were obtained by direct interview using questionnaire. Age and menopausal status were matched and 51 cases and 102 controls were finally selected. Odds ratio and 95% confidence interval were estimated by multiple logistic regression after adjusting for age, education, body mass index, smoking history, drinking history, menstrual regularity, age at menarch, age at first pregnancy, frequency of fullterm pregnancy, breast feeding history, duration of breast feeding, and family history of breast cancer.
RESULTS
GSTM1-null type showed no significance related to the risk of benign breast disorder(adjusted OR=0.8, 95% CI=0.38-1.83) and GSTT1-null type was also not significant(adjusted OR=1.4, 95% CI=0.63-3.29). Increasing tendency of disease risk by the number of GSTs null type was not observed (ptrend>0.1) after adjusting for all other variables.
DISCUSSIONS
Further investigation with larger sample size should be needed to provide more concrete information on the role of GST genetic polymorphism in benign breast cancer and a lots of studies relation in normal level of GST genetic polymorphism in general population should be performed.; Summary

The Study on the Association between Smoking and Coronary Artery Stenosis in Some Autopsy Cases.: Ik Jo Chung, Ki Soon Kim, Jong Park, So Yeon Ryu, Youn Shin Kim, Won Tae Lee, Sung Chul Lim; Korean J Epidemiol. 2000;22(1):42-51.

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Coronary artery disease(CAD), such as atherosclerosis, myocardial infarction and sudden death has been considered the major cause of death for decades and their incidence and prevalence are still increasing. Numerous studies have been done on the risk factor analysis of CAD. But, they were usually based on the clinical and epidemiologic studies of the living patients. The purpose of this study was to evaluate the risk factors for the cardiovascular diseases in autopsy cases from Korean men. The author analysed 81 cases of heart who underwent legal autopsy from Aug. to Dec. 1998. The author measured percent stenosis of coronary artery, site of stenosis, perimeter of aorta, heart weight, body weight, and height and checked the past history including smoking, drinking and age. The results were as follows: 1) Coronary artery stenosis had a positive correlation with age, perimeter of aorta and smoking, but had no correlation with body weight, height, body mass index, heart weight, and drinking. 2) According to the logistic regression analysis, smoking amount and age were significantly associated with coronary artery stenosis. In conclusion, smoking was the most significant independent variable for coronary artery stenosis of some Korean men.; Summary

The Effect of Vitamin Supplementation on Cognitive Function in the Elderly.: Sam Soon Lee, Byung Yeol Chun, Sang Soon Kim; Korean J Epidemiol. 2000;22(1):32-41.

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Abstract PDF: Abstract
OBJECTIVES
To estimate the effects of an oral vitamin supplementation on cognitive function in the elderly, 254 elderly people(experiment group) who were received an oral vitamin supplement for one-year was compared with 292 elderly who were treated as the control group in Koje city during the study period(from February 1997 to March 1998).
METHODS
The cognitive function was tested by mini-mental state examination Korea(MMSE-K). Multiple regression analysis was done to control other confounding variables such as gender, age, educational level, smoking, alcohol, a past 15-day medical history, satisfaction for living cost, family number, cognitive function of the baseline survey.
RESULTS
In the baseline survey, the prevalence of cognitive impairment was 31%(mild impairment 12.5% and severe impairment 18.5%). There was a significant difference(0.76) in cognitive change in the elderly between two groups, 0.68 improved in the experiment group and 0.08 worsen in the control group(p<0.01). In multiple regression analysis, the significant variables were an oral vitamin supplementation, a past 15-day medical history, family number, cognitive function of baseline survey(p<0.05). The improvement of cognitive function was observed in those who do not have a past 15-day medical history, have a large family number, and have a low cognitive function of the baseline survey.
CONCLUSIONS
It appears that an oral vitamin supplementation was effective in improving the cognitive function in the elderly and more effective in the cases with abnormal cognitive function.; Summary

Epidemiologic Study for the Association between Phenol Contaminated Drinking Water and Poor Pregnancy Outcomes in Taegu City.: Jung Han Park, Ju Young Lee; Korean J Epidemiol. 2000;22(1):20-31.

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From 14 to 17 March 1991 the Nakdong River which is a major source of drinking water for Taegu was contaminated with phenol that was spilled out of a factory in Gumi industrial park. Many people who drank the contaminated water complained of various symptoms and were apprehensive of possible adverse effect to the fetus. This study was conducted to examine the effect of drinking water contaminated with phenol on pregnancy outcome in Taegu. All of livebirths and stillbriths delivered in the 5 General Hospitals in Taegu during 1 year from 1 April 1991 were included for this study. For this duration, total number of babies delivered in the 5 General Hospitals was 21,196. Among them, 77.7%(16,468) were delivered from women living in Taegu and it accounted for 47.5% of 34,688 livbirths registered in Taegu during the same period. The babies born to the women living in Taegu were divided into phenol-exposed and unexposed groups. Exposed group was the residents of the area where contaminated water was supplied and they accounted for 81.4% of the women included for this study. Unexposed group was the residents of the area where drinking water was not contaminated with phenol and they accounted for 18.6% of the study subjects. Data were abstracted from the hospital records. All the rates were adjusted for the maternal age and parity by direct method. The abortion rates for the exposed group was 1.7 per 1,000 abortions and livebirths and 1.6 for the unexposed group. The stillbirth rate for the exposed group was 10.5 per 1,000 livebirths and stillbirths 20 weeks of gestation and 9.5 for unexposed group. The early neonatal death rate(within the 1st week after birth) for the exposed group was 7.8 per 1,000 livebirths and 5.4 for the unexposed group. The perinatal death rate for the exposed group was higher as 14.1 per 1,000 livebirths and stillbirths 28 weeks of gestation than 10.8 for the unexposed group. The proportions of intrauterine growth retardation(IUGR) were 2.7% for the exposed group and 3.3% for the unexposed group. Congenital anomaly incidence rates per 1,000 livebirths was 7.4 for the exposed group and 8.4 for the unexposed group. The low birthweight incidence rate for the exposed group was 6.6% and 6.5% for the unexposed group. These differences between two groups were not statistically significant. The premature birth rate(< 37 completed gestational week) was 6.0% for the exposed group and 4.8% for the unexposed group and the difference was statistically significant(p<0.05). Monthly variation of these indices did not show any clue that suggested concurrent change with the phenol contamination of the drinking water. There were no sufficient evidence that could support the hypothesis of adverse effects of phenol contaminated water on pregnancy outcome, such as abortion, stillbirth, premature birth, IUGR, congenital anomalies and early neonatal death.; Summary

A Case-Control Study on Risk Factors of Benign Breast Disorders in Korea.: Sue Kyung Park, Keun Young Yoo, Daehee Kang, Sook Un Kim, Sang Yun Lee, Hyung June Im, Hee Jun Kang, Dong Young Noh, Kuk Jin Choe; Korean J Epidemiol. 2000;22(1):11-19.

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Abstract PDF: Abstract
PURPOSE
A hospital-based case-control study was conducted to figure out the risk factors for benign breast disorders in Korea. MATERIALS AND METHODS: Histologically confirmed incident cases of benign breast disorders(n=54) were selected from inpatients with life-style information at the Department of General Surgery, Seoul National University Hospital during 1994 to 1997. Women with free of self-reporting past history of any malignancies were regarded as controls who were selected from the inpatients at the same department of the same hospital(n=180). Information on life-styles including reproductive factors were obtained by direct interview using questionnaire. Adjusted odds ratios and 95% confidence intervals were estimated by multivariate logistic regression model with matching variables.
RESULTS
Overall, higher educational level, family history of breast cancer, alcohol drinking, and older age at first fullterm pregnancy related to the risk of benign breast disorders. For premenopausal women, older age, higher educational level, and family history of breast cancer increased the risk of benign breast disorders. For postmenopausal women, alcohol drinking, older age at first fullterm pregnancy, and more frequent experiences of fullterm pregnancy increased the risk. Elder age in postmenopausal women and the experience of breast feeding had, however, protective effect against benign breast disorders.
CONCLUSIONS
Although the risk factors for benign breast disease may differ from those for breast cancer, these findings are consistent with the hypothesis of excessive circulating estrogen. The present data indicate some risk factors of benign breast disorders are confirmed as risk factors for breast cancer though a substantial agreement between the risk factors for (pathologically confirmed) benign and malignant breast disease.; Summary

An Epidemiologic Investigation of Shigellosis Outbreak in Gangnung 1998.: Sang Hyuk Jung, Woong Sub Park; Korean J Epidemiol. 2000;22(1):1-10.

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An epidemiologic investigation was carried out to identify the distribution and the cause of Shigellosis outbreak, which was occurred in Gangnung city from August to November, 1998. This study carried out from September, 14, to November, 20, 1998. The total number of Shigellosis confirmed patient is 87. We surveyed and obtained the stool sample from all suspected patients and their members of household. The major findings of this study are as follows. 1. The first patient appeared in September 11 and the number of patients increased to September 13, that is peak time, and the patient number tailed down apparently from September, 18, 1998. 2. The incidence rate per 1,000 is largest in Wangsan-Myeon Doma-Ri(32.9), and second largest in Wangsan-Myeon Mokgea-Ri(31.6), The total incidence rate in Gangnung-shi is 0.4(0.4 for man and 0.3 for woman). The age group with the largest incidence rate per 1,000 is 5-14 age group whose incidence rate is 1.4. 3. The secondary generation attack rate in confirmed patient family is 20.6%, and the secondary attack is 7.8%. 4. We considered the meal of school, environmental factor, milk, carrier of Shigellosis as the cause of outbreak, but we were not able to identify the bacteria of shigellosis. But we suspected the meal of school that played important role in outbreak, because outbreak occurred explosively after students ate the meal of school. 5. We considered three hypotheses for the cause of the outbreak. First, a propagation from external regions; Second, an outbreak from contaminated foods; Third, a propagation from carriers in Gangnung. In order to obtain the further information for first and third hypothesis, we should perform PFGE(Pulsed-field gelectrophoresis) with the shigella bacteria of each epidemic region.; Summary

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