The association of mammographic density with ductal carcinoma in situ of the breast: the Multiethnic Cohort

INTRODUCTION: It is well established that women with high mammographic density are at greater risk for breast cancer than are women with low breast density. However, little research has been done on mammographic density and ductal carcinoma in situ (DCIS) of the breast, which is thought to be a precursor lesion to some invasive breast cancers. METHOD: We conducted a nested case-control study within the Multiethnic Cohort, and compared the mammographic densities of 482 patients with invasive breast cancer and 119 with breast DCIS cases versus those of 667 cancer-free control subjects. A reader blinded to disease status performed computer-assisted density assessment. For women with more than one mammogram, mean density values were computed. Polytomous logistic regression models were used to compute adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for two measurements of mammographic density: percentage density and dense area. RESULTS: Mammographic density was associated with invasive breast cancer and breast DCIS. For the highest category of percentage breast density (≥50%) as compared with the lowest (<10%), the OR was 3.58 (95% CI 2.26–5.66) for invasive breast cancer and 2.86 (1.38–5.94) for breast DCIS. Similarly, for the highest category of dense area (≥45 cm(2)) as compared with the lowest (<15 cm(2)), the OR was 2.92 (95% CI 2.01–4.25) for invasive breast cancer and 2.59 (1.39–4.82) for breast DCIS. Trend tests were significant for invasive breast cancer (P for trend < 0.0001) and breast DCIS (P for trend < 0.001) for both percentage density and dense area. CONCLUSION: The similar strength of association for mammographic density with breast DCIS and invasive breast cancer supports the hypothesis that both diseases may have a common etiology

Understanding the environmental impacts of large fissure eruptions: Aerosol and gas emissions from the 2014-2015 Holuhraun eruption (Iceland)

The 2014-2015 Holuhraun eruption in Iceland, emitted ~11 Tg of SO2 into the troposphere over 6 months, and caused one of the most intense and widespread volcanogenic air pollution events in centuries. This study provides a number of source terms for characterisation of plumes in large fissure eruptions, in Iceland and elsewhere. We characterised the chemistry of aerosol particle matter (PM) and gas in the Holuhraun plume, and its evolution as the plume dispersed, both via measurements and modelling. The plume was sampled at the eruptive vent, and in two populated areas in Iceland. The plume caused repeated air pollution events, exceeding hourly air quality standards (350 µg/m3) for SO2 on 88 occasions in Reykjahlíð town (100 km distance), and 34 occasions in Reykjavík capital area (250 km distance). Average daily concentration of volcanogenic PM sulphate exceeded 5 µg/m3 on 30 days in Reykjavík capital area, which is the maximum concentration measured during non-eruptive background interval. There are currently no established air quality standards for sulphate. Combining the results from direct sampling and dispersion modelling, we identified two types of plume impacting the downwind populated areas. The first type was characterised by high concentrations of both SO2 and S-bearing PM, with a high Sgas/SPM mass ratio (SO2(g)/SO42-(PM) >10). The second type had a low Sgas/SPM ratio (<10). We suggest that this second type was a mature plume where sulphur had undergone significant gas-to-aerosol conversion in the atmosphere. Both types of plume were rich in fine aerosol (predominantly PM1 and PM2.5), sulphate (on average ~90% of the PM mass) and various trace species, including heavy metals. The fine size of the volcanic PM mass (75-80% in PM2.5), and the high environmental lability of its chemical components have potential adverse implications for environmental and health impacts. However, only the dispersion of volcanic SO2 was forecast in public warnings and operationally monitored during the eruption. We make a recommendation that sulphur gas-to-aerosol conversion processes, and a sufficiently large model domain to contain the transport of a tropospheric plume on the timescale of days be utilized for public health and environmental impact forecasting in future eruptions in Iceland and elsewhere in the world

Memorandum of understanding between the Department of Health and the Department of Land and Natural Resources regarding the regulatory oversight of geothermal well drilling

"The purpose of this Memorandum of Understanding (MOU) is to clarify and to facilitate the coordination of regulatory responsibilities between the DEPARTMENT OF HEALTH (DOH) and the DEPARTMENT OF LAND AND NATURAL RESOURCES (DLNR) for the cooperative regulatory oversight of geothermal well drilling. The implementation of the purposes of the MOD will assure that all geothermal drilling activities are appropriatelymonitored by the State to minimize the potential for adverse impacts on health and safety of personnel involved in the project and residents of nearby communities.

A study of the health status of a population exposed to low levels of hydrogen sulfide (and other geothermal effluents) in Puna, Hawaii : preliminary report

The Kilauea East Rift Zone on the Island of Hawaii is one of the most promising areas for geothermal energy development in Hawaii. Since the drilling of the first successful geothermal wells in 1976, residents in the area have raised concerns that hydrogen sulfide (H2S) released into the atmosphere from geothermal wells may be adversely affecting their health. The emission of H2S gas is currently considered to be the most important public health problem related to the utilization of geothermal energy. Although H2S is unquestionably a toxic gas at high concentrations, experts disagree on the lowest levels at which adverse health effects may occur; very little is known about health effects that may be related to long-term, low-level exposure. In February 1984, the State Department of Health (DOH) conducted a door-to-door health interview survey of a residential community, Leilani Estates, located near a two megawatt geothermal power plant in the Puna District. The primary purposes of this survey were to establish the health status of this community and to compare the health status of this community to another community in Puna, Hawaiian Beaches Estates, and to other areas of Hawaii. Ambient H2S air monitoring data from three monitoring stations in Leilani Estates and a station recently established in Hawaiian Beaches Estates was supplied by the Hawaii Geothermal Project. The health survey utilized a form adapted from the National Health Survey, National Center for Health Statistics, and consists of both demographic and health-oriented questions. This form is used by the Hawaii Health Surveillance Program (HSP), DOH, for the on-going, state-wide Hawaii Health Survey. This allowed for the comparison of the prevalence of reported health conditions in Leilani Estates to the State as a whole and Hawaii County. A supplemental questionnaire form was also administered to gather more detailed information on chronic respiratory conditions and to determine the perception of nuisances (i.e., noise and odor) perceived by residents in Leilani Estates to be associated with geothermal development. Interviews were administered by HSP to 135 (88.8%) of the 152 eligible households in Leilani Estates, representing a total of 350 individuals who live in the area. The rates of all acute and chronic health conditions reported in Leilani Estates were found to be similar to Hawaiian Beaches Estates with the exception of the "common cold," which was substantially higher in Leilani Estates in January 1984. There were no statistically significant differences in other measures of disability in terms of "bed days'' due to chronic conditions and ''activity limitation days over the past month" between these two communities. Perhaps most noteworthy, the rates of chronic respiratory conditions including ''bronchitis/emphysema,'' ''asthma,'' ''hayfever,'' ''sinusitis'' and ''other respiratory system disease" were found to be similar in Leilani Estates and Hawaiian Beaches Estates from January 1983 - January 1984. These conditions have been most often associated with long-term exposure to air pollutants. However, the prevalence rates of a number of acute and chronic health conditions in these study areas were higher than Hawaii County and Hawaii statewide rates reported for 1983, including all chronic respiratory conditions. These differences may be due in part to expected seasonal fluctuation in disease prevalence, differing demographic features that may affect disease prevalence and reporting, and/or other environmental factors (e.g., exposure to pollens or fungi) may be involved and are discussed. Results of air monitoring from three monitoring stations in Leilani Estates during the period extending from January 1983 - January 1984 indicated hydrogen sulfide (H2S) levels ranged from below the reliable detection limit (5 ppb) to ll ppb, based on one-hour averages. Average one-hour levels of H2S in Hawaiian Beaches never exceeded the detection limit. Subsequent air monitoring results have indicated that ambient H2S levels in Leilani Estates may be higher during open, unabated venting of effluent from nearby geothermal wells. Due to venting from natural volcanic fumaroles in the area, the contribution of H2S from geothermal wells was difficult to assess accurately.It could not be determined that H2S produced as a result of geothermal development in the area was responsible for any of the health conditions reported in Leilani Estates. Further studies are required to determine what factors account for the relatively high rates of chronic respiratory conditions reported in the areas surveyed in Puna when compared to average State-wide and County-wide rates. Recommendations are included in this report with regard to the utility of conducting further surveys to address community concerns of adverse health effects associated with geothermal development in Hawaii."The preparation of this report was financed in part by the Coastal Zone Management Act of 1972.

Effects of age, ethnicity and menopause on ambulatory blood pressure: Japanese-American and Caucasian school teachers in Hawaii

Ambulatory blood pressure (BP) measurements of 120 female teachers of Japanese-American or Caucasian ethnicity working in public schools located in Hilo, Hawaii, were recorded. BP was measured at 15-min intervals during waking hours and 30-min intervals during sleep over a 24-hr period that included a full work day. These measurements were averaged during three daily settings: at work, at home while awake (“home”), and during sleep. ANCOVAs using ethnicity as a predictor variable of BP, with age and the body mass index (BMI) as covariates, show a significant interaction effect between age and ethnicity in some daily settings. Among Japanese-Americans partial correlations between age and systolic BP controlling for the BMI are significant in these settings, while among Caucasians none of the correlations are significant. Menopausal status is not significantly related to BP when age is controlled in analyses. There was no significant ethnic difference in number of symptoms reported, including frequency of “hot flushes/flashes,” within the past two weeks. Those who reported hot flushes had significantly elevated BP in waking settings but not during sleep. The greater increase in BP with age in Japanese-Americans may be related to their elevated risk for development of hypertension. The lack of a significant relationship between menopausal status and BP may be due to the high rate of usage of hormonal replacement therapy in this sample, as well as an unusually high rate of hysterectomy

Results of a lay health education intervention to increase colorectal cancer screening among Filipino Americans: A cluster randomized controlled trial

BACKGROUND:Filipino colorectal cancer (CRC) screening rates fall below Healthy People 2020 goals. In this study, the authors explore whether a lay health educator (LHE) approach can increase CRC screening among Filipino Americans ages 50 to 75 years in Hawai'i. METHODS:A cluster randomized controlled trial from 2012 through 2015 compared an intervention, which consisted of LHEs delivering 2 education sessions and 2 telephone follow-up calls on CRC screening plus a CRC brochure versus an attention control, in which 2 lectures and 2 follow-up calls on nutrition and physical activity plus a CRC brochure were provided. The primary outcome was change in self-reported ever receipt of CRC screening at 6 months. RESULTS:Among 304 participants (77% women, 86% had &gt; 10 years of residence in the United States), the proportion of participants who reported ever having received CRC screening increased significantly in the intervention group (from 80% to 89%; P = .0003), but not in the control group (from 73% to 74%; P = .60). After covariate adjustment, there was a significant intervention effect (odds ratio, 1.9; 95% confidence interval, 1.0-3.5). There was no intervention effect on up-to-date screening. CONCLUSIONS:This first randomized controlled trial for CRC screening among Hawai'i's Filipinos used an LHE intervention with mixed, but promising, results. Cancer 2018;124:1535-42. © 2018 American Cancer Society