A case-control study of multiple myeloma nested in the American Cancer Society prospective study

Our plain-English summary of A case-control study of multiple myeloma nested in the American Cancer Society prospective study, by P. Boffetta, S.D. Stellman, L. Garfinkel (International Journal of Cancer, 1989).

The study

• Authors: P. Boffetta, S.D. Stellman, L. Garfinkel
• Journal: International Journal of Cancer
• Published: 1989;43(4):554-9
• Cited by: 108 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003940).

Abstract

Among the subjects enrolled in the American Cancer Society Cancer Prevention Study II, a large nation-wide prospective study, 282 died from multiple myeloma (MM) during the first 4 years of follow-up. These were divided into incident cases who were initially free from disease and prevalent cases who reported MM or related symptoms at the time of enrollment. For each case, 4 controls matched for age, sex, ethnic group and residence were randomly selected. Previous history of diabetes [odds ratio (OR) = 2.0] and employment as farmer (OR = 2.7) were the risk factors consistently suggested by the results of the analysis. The risk associated with farming showed a linear trend with duration of exposure. Pesticide or herbicide exposure was not a risk factor per se but, when combined with farming, it increased the OR to 4.3. Low education, occupational exposure to dyes, and employment in a bank, on the railroad or as a maid were also suggested risk factors, but either they were not statistically significant or they were based on small numbers of exposed subjects. No association between MM and asbestos exposure was observed.

In plain English

This case-control study was nested in the American Cancer Society's Cancer Prevention Study II. In 1982 it enrolled over 1.2 million US adults, who completed a questionnaire on health, habits, jobs and exposures. Within up to 4 years, 282 enrollees died with multiple myeloma recorded on their death certificate. The authors separated 128 "incident" cases, with no mention of the disease or related symptoms at enrollment, from 154 "prevalent" cases. Each case had 4 controls matched by sex, birth year, ethnic group and area. For 9 cases, age was matched only within 2 or 5 years. Self-reported asbestos exposure was not associated with multiple myeloma. Among incident cases, 3 cases and 17 controls reported it (odds ratio 0.7, 95% CI 0.2-2.4). For prevalent cases it was 1.3 (95% CI 0.6-2.9). The authors reported about 52% power to detect a doubling of risk among incident cases. Among incident cases, prior diabetes (adjusted odds ratio 2.0, 95% CI 1.1-3.8) and farming (2.7, 95% CI 1.3-5.7) were the factors that consistently appeared. The authors noted limitations, including reliance on death certificates and small size.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case-control study nested in a nationwide prospective mortality study (American Cancer Society Cancer Prevention Study II)
• Who was studied: The study drew on 508,637 men and 676,613 women enrolled in 1982 across the United States. Cases were 282 people whose death certificates mentioned multiple myeloma within the first 4 years of follow-up (2 years in 10 of 58 divisions). There were 128 incident cases with 512 controls and 154 prevalent cases with 616 controls. Each case had 4 controls matched for sex, ACS division, year of birth and ethnic group. For 9 cases, age matching was only within 2 years (8 cases) or 5 years (1 case).
• Exposure: Self-reported exposure at work or in daily life to 12 groups of substances, including asbestos and pesticides or herbicides. The study also covered occupation, coded into 65 categories, along with health history and lifestyle factors.
• Main results:
  • Incident cases: 3 exposed cases and 17 exposed controls reported asbestos exposure, with a matched odds ratio of 0.7 (95% CI 0.2-2.4). These values were read from the OCR-scrambled Table III.
  • Prevalent cases: the absence of an association with asbestos was confirmed (odds ratio 1.3, 95% CI 0.6-2.9; printed as "I .3" by OCR).
  • Incident cases: the analysis had about 52% power to detect an odds ratio of 2 and about 90% power to detect an odds ratio of 3.
  • Incident cases, adjusted logistic regression: previous history of diabetes had an odds ratio of 2.0 (95% CI 1.1-3.8).
  • Incident cases, adjusted logistic regression: employment as a farmer had an odds ratio of 2.7 (95% CI 1.3-5.7).
  • Farming and diabetes were the factors that consistently appeared in this cohort.
  • Pesticide and herbicide exposure was associated with multiple myeloma among farmers but not among non-farmers.
• The authors' conclusion: The authors concluded that, in this analysis, asbestos exposure did not appear to be a risk factor for multiple myeloma.
• Limitations the authors state:
  • Diagnoses of cases were based on death certificates only.
  • The self-administered questionnaire gave only limited information on chronic diseases, diet and occupation.
  • The study's small size limited the power to analyze many associations in detail.
  • Self-reported exposures to specific chemicals may be more prone to recall bias than occupational history.

Topics

Medical terms in this study, explained in our Lexicon: Case-Control Study, Myeloma, Odds Ratio, Occupational Exposure, Asbestos Exposure.

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• Prediagnostic detection of mesothelioma by circulating calretinin and mesothelin - a case-control comparison nested into a prospective cohort of asbestos-exposed workers — G. Johnen, K. Burek, et al. (2018)
• Cancer mortality and wood dust exposure among participants in the American Cancer Society Cancer Prevention Study-II (CPS-II) — S.D. Stellman, P.A. Demers, et al. (1998)
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