1. Researchers conduct a case-con troll study of breast cancer, using incident case.

The

researchers find out that 90% of the cases had taken hormonal contraceptives in the past.

Should the researchers conclude that hormonal contraceptives increase the risk of developing

breast cancer? Why?

Based solely on the information provided, it would not be appropriate for the researchers to conclude

that hormonal contraceptives increase the risk of developing breast cancer. While it is true that 90% of the cases

had taken hormonal contraceptives in the past, this does not establish a causal relationship between the use of

hormonal contraceptives and the development of breast cancer.

There are several factors to consider before drawing such a conclusion:

1. Correlation vs. causation: The fact that a high percentage of breast cancer cases had taken hormonal

contraceptives does not necessarily mean that the contraceptives caused the cancer. It is possible that other

factors, such as genetic predisposition, lifestyle choices, or environmental factors, could be contributing to the

development of breast cancer in these individuals.

2. Confounding variables: There may be confounding variables that are influencing the relationship between

hormonal contraceptive use and breast cancer risk. For example, women who use hormonal contraceptives may

also be more likely to have regular gynecological check-ups, which could lead to earlier detection of breast

cancer. Without controlling for these confounding variables, it is difficult to determine the true relationship

between hormonal contraceptive use and breast cancer risk.

3. Selection bias: The study may suffer from selection bias if the sample of breast cancer cases is not

representative of the general population. For example, if the study only includes breast cancer cases from a

particular demographic group or geographic area, the results may not be generalizable to the broader

population.
4. Recall bias: The accuracy of self-reported contraceptive use may be subject to recall bias, as individuals may

not accurately remember or report their past contraceptive use. This could lead to inaccuracies in the data and

potentially biased results.

To establish a causal relationship between hormonal contraceptive use and breast cancer risk, further

research is needed, ideally through well-designed prospective cohort studies or randomized controlled trials.

These studies would help to control for confounding variables, minimize bias, and provide more reliable

evidence on the potential link between hormonal contraceptive use and breast cancer risk. Until such evidence

is available, it would be premature for researchers to conclude that hormonal contraceptives increase the risk of

developing breast cancer based solely on the findings of this case-control study.

2. Researchers conduct a case-control study of pancreatic cancer. The study included 200 cases

and 200 controls. Of the cases, 80% reported they smoked cigarettes. Among the controls, 50%

reported they smoked cigarettes.

a) Prepare a 2 x 2 table with these data

b) Calculate the exposure odds ratio

c) Interpret the exposure odds ratio in a sentence

(a)

Pancreatic Cancer Non Pancreatic cancer Total

Smoker 160 100 260
Non smoker 40 100 140
Total 200 200 400
b) To calculate the exposure odds ratio, we first need to calculate the odds of exposure (smoking) among the

cases and controls:

Odds of smoking among cases = Number of smoking cases / Number of non-smoking cases = 160/40 = 4

Odds of smoking among controls = Number of smoking controls / Number of non-smoking controls = 100/100

=1

Next, we calculate the exposure odds ratio:

Exposure odds ratio = (Odds of exposure among cases) / (Odds of exposure among controls)

=4/1

=4

c) The exposure odds ratio of 4 means that individuals with pancreatic cancer were four times more likely to

have a history of smoking compared to individuals without pancreatic cancer.

3. 6,750 people who were free of disease X were enrolled in a cohort study in 1985 and

followed with annual exams and interviews through 1995. Exposure to factor A was determined

at study enrollment and the participants were followed until 1995 to observe new cases of

disease X. Data from the study at the end of follow-up are shown in the following table.

Exposure to Factor A People with Disease X People without Disease X

No exposed 30 3720

Exposed 120 2880

a) What is the Incident rate of disease X among person exposed to factor A?

b) What is the Incident rate of disease X among person not exposed to factor A?

c) What is the Incident rate of disease X?

d) Calculate the relative risk (RR)

e) Interpret Relative risk (RR) in a sentence