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As the largest study to date on risk factors and comorbidities associated with PBC, the results support some of the previously proposed risk factors for PBC, but not others, such as the increased prevalence of breast cancer in female PBC patients. "We further identified new putative risk factors (the use of cosmetic products) and autoimmune conditions (SLE) associated with PBC," the authors report.

The study may have been limited by differing socioeconomic status between cases and controls since reported annual household income was significantly higher in patients with PBC. Also misclassifications may have occurred in the course of self-reporting. "Despite these limitations," say the authors, "we believe that our findings represent the soundest evidence of associations yet reported for PBC."

They conclude: "the results indicate that environmental factors, possibly including infectious agents through urinary tract infections of chemicals contained in cigarette smoke, may induce PBC in genetically susceptible individuals. Exogenous estrogens may also contribute to explain the female predominance of the disease."

The authors suggest future efforts should concentrate on interactions of genetic and environmental factors in relation to PBC. They propose a worldwide gene database for PBC patients and family members as well as animal studies with the identified agents. "Only these combined efforts will provide the solution to the enigma of PBC etiology," they say.

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Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
1-Nov-2005