This article was downloaded by: [University of Arizona] On: 05 February 2015, At: 08:52 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Nutrition and Cancer Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hnuc20
Patterns of milk consumption and risk of cancer a
b
Curtis J. Mettlin , Elinor R. Schoenfeld & Nachimuthu Natarajan
a
a
Department of Cancer Control and Epidemiology , Roswell Park Memorial Institute , 666 Elm St., Buffalo, NY, 14263 b
Department of Community Medicine , State University of New York , Stony Brook, NY, 11794 Published online: 04 Aug 2009.
To cite this article: Curtis J. Mettlin , Elinor R. Schoenfeld & Nachimuthu Natarajan (1990) Patterns of milk consumption and risk of cancer, Nutrition and Cancer, 13:1-2, 89-99, DOI: 10.1080/01635589009514049 To link to this article: http://dx.doi.org/10.1080/01635589009514049
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/ terms-and-conditions
Patterns of Milk Consumption and Risk of Cancer
Downloaded by [University of Arizona] at 08:52 05 February 2015
Curtis J. Mettlin, Elinor R. Schoenfeld, and Nachimuthu Natarajan
Abstract The reported milk consumption habits of 3,334 cancer patients and 1,300 comparable control subjects seen at Roswell Park Memorial Institute were studied. The cancer patient group included persons diagnosed with cancers of the oral cavity, stomach, colon, rectum, lung, breast, uterus, cervix, prostate, or bladder. Data were obtained by means of a standardized admissions questionnaire. As a group, control patients were more likely to report never drinking whole milk; cancer patients more often reported frequent consumption of whole milk. Relative risks of different patterns of milk consumption for specific cancer diagnoses, adjusted for sex, age, smoking history, education, and county of residence, were calculated with multiple logistic regression analysis. Elevated risks for frequent consumption of whole milk relative to not drinking milk were observed for cancers of the oral cavity, stomach, colon, rectum, lung, bladder, breast, and cervix. Reduced risks for frequent consumption of 2% milk relative to not drinking milk were observed for cancers of the oral cavity, stomach, rectum, lung, and cervix. Preference for exclusive consumption of reducedfat milk was linked to significant risk reduction for oral and cervical cancers, and drinking only whole milk was linked to significant risk increases for cancers of the oral cavity, stomach, rectum, lung, and breast. Some associations were observed for a computed index of milk fat intake, but the overall pattern of effects was not fully explained by variations in fat content. The effects observed for some sites may be confounded by other dietary or nondietary correlates of risk. (Nutr Cancer 13, 89-99, 1990)
Introduction The consumption of milk is a common dietary habit in the United States. Milk is a major contributor of important nutrients, and its consumption is widely promoted as a health habit. Milk is, however, a major source of dietary fat, and animal fat consumption has been hypothesized to be a source of risk for several major cancers, including cancers of the colon and rectum, breast, and prostate (1). On the other hand, milk is a source of some nutrients C.J. Mettlin and N. Natarajan are affiliated with the Department of Cancer Control and Epidemiology, Roswell Park Memorial Institute, Buffalo, NY 14263. E.R. Schoenfeld is affiliated with the Department of Community Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794.
Copyright © 1990, Lawrence Erlbaum Associates, Inc.
hypothesized to protect against cancer, such as vitamins A and D, riboflavin, and calcium (2-6). Thus, we examined the association of patterns of milk consumption with several different types of cancer among patients seen at Roswell Park Memorial Institute (RPMI) in Buffalo, NY. Although milk drinking has been included occasionally as a variable in other epidemiological studies, our investigation may be unique in examining both the frequency and type of milk consumed and in applying a standard methodology across different cancer types.
Downloaded by [University of Arizona] at 08:52 05 February 2015
Materials and Methods
Beginning in 1982 and continuing to the present, all patients entering RPMI were invited to provide epidemiological data for research purposes by completing a questionnaire. The participation is voluntary and unrelated to treatment. The questionnaire is designed to be completed by the patient and includes questions concerning smoking, alcohol use, diet, work, family health, residence, and personal medical history. Patients are followed by the RPMI staff through and after their admission to encourage response and to assist patients who may not follow instructions completely or who omit essential information. The procedure is modeled after a similar program at RPMI (1957-1965) from which other findings have been reported (3,7-9). The epidemiological data subsequently are matched to diagnostic information recorded in the RPMI hospital tumor registry and the index of discharge diagnoses. Based on these data, we selected from the initial 9,682 patient series those diagnoses having a frequency greater than 100. These included the following sites: oral cavity, stomach, colon, rectum, lung, female breast, bladder, cervix uteri, uterus, prostate, and bladder. The numerical distribution of cases is shown in Table 1. RPMI is known mainly as a cancer treatment and research center, but many patients are seen for reasons that do not result in a diagnosis of malignancy. From the 3,928 such patients in our initial series, 1,300 were selected to serve as a basic control population. This number was selected in anticipation that when the largest case group (female breast) was studied, an approximately equal number of female control subjects would be available within the control series. Controls were selected randomly within strata of residence, because cancer patients entering RPMI are more likely to reside outside the Buffalo Standardized Metropolitan Statistical Area (SMSA) compared with potential control patients. This reflects the tendency for patients with more serious illness to travel further for their care. The diagnoses of controls were distributed across 162 disease classifications. The largest categories, acTable 1. Distribution of Cases by Cancer Site" Cancer Site
ICD-0 Codes*
No. of Cases
Oral cavity Stomach
141, 143-145, 149 151 153 154 162 174 180 182 185 188
163 115 504 312 542 848 231 233 442 178
Colon Rectum Lung Breast Uterus Cervix Prostate Bladder
a: Total no. of cases is 3,334. b: ICD-O, International Classification of Diseases for Oncology, World Health Organization (Geneva, Switzerland), 1976.
90
Nutrition and Cancer 1990
counting for 15% and 13%, respectively, were suspicion of neoplastic disease and benign breast disease. No other diagnosis accounted for more than 5% of the total series. Of principal interest here are the questions that asked the patient to report the number of glasses of whole milk, 2% milk, and skim milk he or she usually drank each day. The questionnaire prompted the patient to consider general habits immediately preceding the onset of the current illness. The scale offered included the values 0, less than 1, 1, 2, 3, 4, 5, 6, and more than 6. Education was measured by a six-point scale ranging from less than eight grades to college graduate; smoking history was measured by the total number of years the patient reported smoking cigarettes, regardless of present smoking status. Analyses were performed with cross-tabulation and multiple logistic regression procedures utilizing the Newton-Raphson interactive technique (10) programmed for an IBM-compatible computer. Results Downloaded by [University of Arizona] at 08:52 05 February 2015
Table 2 compares the characteristics of the overall case series with the controls. Analyses by specific cancer diagnosis follow; however, these data illustrate some of potential sources of bias and confounding that may be encountered in comparing cancer patients in general and others entering RPMI. Persons ultimately diagnosed with a cancer included in our series tend to be older than those with a noncancer diagnosis, and a greater proportion are male. Cancer patients tend to have somewhat lower educational achievements than controls do. Table 2. Demographics of Cases and Controls Controls*
Cancer Diagnosis Cases" No.
Percent
1,446 1,838
44.3% 55.7%
450 850
34.6% 65.4%
3,238 96
97.1% 2.9%
1,233 67
94.8% 5.2%
1,209 2,125
36.3% 63.7%
500 800
38.5% 61.5%
227 289 €02 1.C68 541 535
7.0% 8.9% 18.5% 32.7% 16.6% 16.4%
43 55 185 416 270 298
3.4% 4.3% 14.6% 32.8% 21.3% 23.5%
Sex Male Female Race White Nonwhite Residence Buffalo SMSA Outside Buffalo SMSA Education
Nutrition and Cancer Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hnuc20
Patterns of milk consumption and risk of cancer a
b
Curtis J. Mettlin , Elinor R. Schoenfeld & Nachimuthu Natarajan
a
a
Department of Cancer Control and Epidemiology , Roswell Park Memorial Institute , 666 Elm St., Buffalo, NY, 14263 b
Department of Community Medicine , State University of New York , Stony Brook, NY, 11794 Published online: 04 Aug 2009.
To cite this article: Curtis J. Mettlin , Elinor R. Schoenfeld & Nachimuthu Natarajan (1990) Patterns of milk consumption and risk of cancer, Nutrition and Cancer, 13:1-2, 89-99, DOI: 10.1080/01635589009514049 To link to this article: http://dx.doi.org/10.1080/01635589009514049
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/ terms-and-conditions
Patterns of Milk Consumption and Risk of Cancer
Downloaded by [University of Arizona] at 08:52 05 February 2015
Curtis J. Mettlin, Elinor R. Schoenfeld, and Nachimuthu Natarajan
Abstract The reported milk consumption habits of 3,334 cancer patients and 1,300 comparable control subjects seen at Roswell Park Memorial Institute were studied. The cancer patient group included persons diagnosed with cancers of the oral cavity, stomach, colon, rectum, lung, breast, uterus, cervix, prostate, or bladder. Data were obtained by means of a standardized admissions questionnaire. As a group, control patients were more likely to report never drinking whole milk; cancer patients more often reported frequent consumption of whole milk. Relative risks of different patterns of milk consumption for specific cancer diagnoses, adjusted for sex, age, smoking history, education, and county of residence, were calculated with multiple logistic regression analysis. Elevated risks for frequent consumption of whole milk relative to not drinking milk were observed for cancers of the oral cavity, stomach, colon, rectum, lung, bladder, breast, and cervix. Reduced risks for frequent consumption of 2% milk relative to not drinking milk were observed for cancers of the oral cavity, stomach, rectum, lung, and cervix. Preference for exclusive consumption of reducedfat milk was linked to significant risk reduction for oral and cervical cancers, and drinking only whole milk was linked to significant risk increases for cancers of the oral cavity, stomach, rectum, lung, and breast. Some associations were observed for a computed index of milk fat intake, but the overall pattern of effects was not fully explained by variations in fat content. The effects observed for some sites may be confounded by other dietary or nondietary correlates of risk. (Nutr Cancer 13, 89-99, 1990)
Introduction The consumption of milk is a common dietary habit in the United States. Milk is a major contributor of important nutrients, and its consumption is widely promoted as a health habit. Milk is, however, a major source of dietary fat, and animal fat consumption has been hypothesized to be a source of risk for several major cancers, including cancers of the colon and rectum, breast, and prostate (1). On the other hand, milk is a source of some nutrients C.J. Mettlin and N. Natarajan are affiliated with the Department of Cancer Control and Epidemiology, Roswell Park Memorial Institute, Buffalo, NY 14263. E.R. Schoenfeld is affiliated with the Department of Community Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794.
Copyright © 1990, Lawrence Erlbaum Associates, Inc.
hypothesized to protect against cancer, such as vitamins A and D, riboflavin, and calcium (2-6). Thus, we examined the association of patterns of milk consumption with several different types of cancer among patients seen at Roswell Park Memorial Institute (RPMI) in Buffalo, NY. Although milk drinking has been included occasionally as a variable in other epidemiological studies, our investigation may be unique in examining both the frequency and type of milk consumed and in applying a standard methodology across different cancer types.
Downloaded by [University of Arizona] at 08:52 05 February 2015
Materials and Methods
Beginning in 1982 and continuing to the present, all patients entering RPMI were invited to provide epidemiological data for research purposes by completing a questionnaire. The participation is voluntary and unrelated to treatment. The questionnaire is designed to be completed by the patient and includes questions concerning smoking, alcohol use, diet, work, family health, residence, and personal medical history. Patients are followed by the RPMI staff through and after their admission to encourage response and to assist patients who may not follow instructions completely or who omit essential information. The procedure is modeled after a similar program at RPMI (1957-1965) from which other findings have been reported (3,7-9). The epidemiological data subsequently are matched to diagnostic information recorded in the RPMI hospital tumor registry and the index of discharge diagnoses. Based on these data, we selected from the initial 9,682 patient series those diagnoses having a frequency greater than 100. These included the following sites: oral cavity, stomach, colon, rectum, lung, female breast, bladder, cervix uteri, uterus, prostate, and bladder. The numerical distribution of cases is shown in Table 1. RPMI is known mainly as a cancer treatment and research center, but many patients are seen for reasons that do not result in a diagnosis of malignancy. From the 3,928 such patients in our initial series, 1,300 were selected to serve as a basic control population. This number was selected in anticipation that when the largest case group (female breast) was studied, an approximately equal number of female control subjects would be available within the control series. Controls were selected randomly within strata of residence, because cancer patients entering RPMI are more likely to reside outside the Buffalo Standardized Metropolitan Statistical Area (SMSA) compared with potential control patients. This reflects the tendency for patients with more serious illness to travel further for their care. The diagnoses of controls were distributed across 162 disease classifications. The largest categories, acTable 1. Distribution of Cases by Cancer Site" Cancer Site
ICD-0 Codes*
No. of Cases
Oral cavity Stomach
141, 143-145, 149 151 153 154 162 174 180 182 185 188
163 115 504 312 542 848 231 233 442 178
Colon Rectum Lung Breast Uterus Cervix Prostate Bladder
a: Total no. of cases is 3,334. b: ICD-O, International Classification of Diseases for Oncology, World Health Organization (Geneva, Switzerland), 1976.
90
Nutrition and Cancer 1990
counting for 15% and 13%, respectively, were suspicion of neoplastic disease and benign breast disease. No other diagnosis accounted for more than 5% of the total series. Of principal interest here are the questions that asked the patient to report the number of glasses of whole milk, 2% milk, and skim milk he or she usually drank each day. The questionnaire prompted the patient to consider general habits immediately preceding the onset of the current illness. The scale offered included the values 0, less than 1, 1, 2, 3, 4, 5, 6, and more than 6. Education was measured by a six-point scale ranging from less than eight grades to college graduate; smoking history was measured by the total number of years the patient reported smoking cigarettes, regardless of present smoking status. Analyses were performed with cross-tabulation and multiple logistic regression procedures utilizing the Newton-Raphson interactive technique (10) programmed for an IBM-compatible computer. Results Downloaded by [University of Arizona] at 08:52 05 February 2015
Table 2 compares the characteristics of the overall case series with the controls. Analyses by specific cancer diagnosis follow; however, these data illustrate some of potential sources of bias and confounding that may be encountered in comparing cancer patients in general and others entering RPMI. Persons ultimately diagnosed with a cancer included in our series tend to be older than those with a noncancer diagnosis, and a greater proportion are male. Cancer patients tend to have somewhat lower educational achievements than controls do. Table 2. Demographics of Cases and Controls Controls*
Cancer Diagnosis Cases" No.
Percent
1,446 1,838
44.3% 55.7%
450 850
34.6% 65.4%
3,238 96
97.1% 2.9%
1,233 67
94.8% 5.2%
1,209 2,125
36.3% 63.7%
500 800
38.5% 61.5%
227 289 €02 1.C68 541 535
7.0% 8.9% 18.5% 32.7% 16.6% 16.4%
43 55 185 416 270 298
3.4% 4.3% 14.6% 32.8% 21.3% 23.5%
Sex Male Female Race White Nonwhite Residence Buffalo SMSA Outside Buffalo SMSA Education
