STROBE 2007 (v4) checklist of items to be included in reports of observational studies

in epidemiology*
Checklist for cohort, case-control, and cross-sectional studies (combined)
Section/Topic
Reported on page #
Recommendation
Title and abstract
(a) Indicate the studys
Yes
( halaman 1) Disebutkan pada Title
design with a commonly
used term in the title or the
Breast Cancer Incidence in a Cohort
abstract
of U.S. Flight Attendants
(b) Provide in the abstract
Yes ( halaman 1) dijelaskan dalam
an informative and
Abstrack
balanced summary of what
was done and what was
Pada bagian abstrack dijelaskan
found
secara ringkas mengenai tujuan,
metode, hasil dan kesimpulan dari
penelitian
Background : Flight attendants may
have elevated breast cancer incidence
(BCI)..
Methods
:
We
collected
questionnaire data on BCI...; We
conducted analyses to evaluate..; We
applied an indirect adjustment to
estimate...
Results : BCI was elevated...
Conclusions : Future cohort
analyses
may...
occupational
exposures and non-occupational risk
factors

Introduction
Background/rational
e

Explain the scientific

background and rationale
for the investigation being
reported

Yes

(halaman 2, paragraf 1) Dijelaskan

pada bagian Introduction yaitu
pramugari mungkin mengalami
peningkatan risiko kanker payudara.
Dikarenakan paparan tempat kerja
seperti radiasi kosmik dan perjalanan
melintasi berbagai zona waktu. Studi
epidemiologi sebelumnya pada 2012
dan 2014 menunjukkan bahwa tidak
ditemukan
adanya
peningkatan
mortalitas
dari
risiko
kanker

payudara pada pramugari.Namun

penelitian lebih awal di tahun 2004
mengungkapkan
bahwa
terjadi
peningkatan risiko kanker payudara
tapi tidak sepenuhnya menjelaskan
faktor risiko yang ada. Penelitian
pada
maskapai
kru
kabin
pesawat Scandinavian tahun
2012
menunjukkan
adanya
peningkatan 50% risiko kanker
payudara. Pada studi kontrolkasus tidak ditemukan adanya
hubungan radiasi kosmik dan
jumlah
penerbangan
lintas
waktu
terhadap
kanker
payudara.

Objectives

State specific objectives,

including any pre-specified
hypotheses

Yes

( halaman 1&2) Dijelaskan pada

Abstrack bagian Background dan
halaman 2 paragraf 2 bagian
Intoduction. Kuesioner berbasis
cohort ini merupakan salah satu cara
untuk memiliki informasi tentang
faktor risiko penting untuk kanker
payudara, seperti riwayat reproduksi
dan riwayat keluarga kanker
payudara pada pramugari.
" This questionnaire-based cohort
represents... family history of breast
cancer"

Methods
Study design

Present key elements of

study design early in the
paper

Yes

(halaman 2) Dijelaskan pada bagian

Methods Cohort Description
Insiden kohort untuk studi ini adalah
bagian dari kelompok kematian
mantan pramugari
"The incidence cohort for this study
is a subset of the mortality cohort...
Pan American World Airways (Pan
Am)"

Setting

Describe the setting,

locations, and relevant
dates, including periods of
recruitment, exposure,
follow-up, and data
collection

Yes

(halaman 2) Dijelaskan pada bagian

Methods
Sukarelawan diambil dari mantan
pegawai maskapai Pan Am yang
telah menundurkan diri pada tahun
1953 atau lebih. Ini termasuk
pegawai (laki-laki dan wanita) yang
telah bekerja setidaknya 1 tahun
menjadi pramugari sebelum Pan Am
berhenti beroperasi pada tahun 1991.
6177 responden diambil melalui
interview telepon serta surat
kuesioner. Dimulai dari 2002-2005.
It was assembled from the
personnel records of Pan Am...
before Pan Am ceased operation in
1991, were U.S, The remaining
living female flight attendants in the
mortality... administered between
August 2002 and July 2005

Participants

(a) Cohort studyGive the

eligibility criteria, and the
sources and methods of
selection of participants.
Describe methods of
follow-up

Yes

(halaman 2) Dijelaskan pada bagian

Methods
Kriteria untuk sukarelawan adalah
pramugari yang telah bekerja
minimal 1 tahun.

Case-control studyGive
the eligibility criteria, and
the sources and methods of
case ascertainment and
control selection. Give the
rationale for the choice of
cases and controls

For cohort members who

subsequently transferred to Pan Am...
establishing the one year minimum
employment criterion for eligibility"

Cross-sectional study
Give the eligibility criteria,
and the sources and
methods of selection of
participants
(b) Cohort studyFor
matched studies, give
matching criteria and
number of exposed and
unexposed

Yes

(halaman 2) Dijelaskan pada bagian

Methods
Peneliti mengambil responden dari
mantan pegawai maskapai Pan Am

Case-control studyFor
matched studies, give
matching criteria and the
number of controls per case

yang telah menundurkan diri pada

tahun 1953 atau lebih. Ini termasuk
pegawai (laki-laki dan wanita) yang
telah bekerja setidaknya 1 tahun
menjadi pramugari sebelum Pan Am
berhenti beroperasi pada tahun 1991.
It was assembled from the
personnel records of Pan Am...
before Pan Am ceased operation in
1991, were U.S

Variables

Clearly define all

outcomes, exposures,
predictors, potential
confounders, and effect
modifiers. Give diagnostic
criteria, if applicable

Yes

(halaman 3) Dijelaskan pada bagian

Cohort Description
Dimana pramugari yang tersisa yang
diundang diminta untuk
berpartisipasi untuk menyelesaikan
pertanyaan tentang informasi
demografi mereka, riwayat kerja dan
faktor resiko non-kerja (misalnya,
riwayat reproduksi dan penggunaan
alkohol, tembakau serta terapi
penggantian hormon)
The remaining living female flight
attendants in the mortality cohort
were invited... reproductive history
and use of alcohol, tobacco, and
hormone replacement therapy
(outcome).

Data sources/
measurement

For each variable of

Yes
interest, give sources of
data and details of methods
of assessment
(measurement). Describe
comparability of
assessment methods if there
is more than one group

(halaman 3&4) Dijelaskan pada

bagian Questionnare Data dan Breast
Cancer Case Ascertainment
" The questionnaire administered to
living participants ...In this analysis,
the non-exposure-related covariates
of interest were age, calendar period,
race, parity... the present analysis
compares the incidence of breast
cancer in the cohort... All cancer
diagnoses obtained from the
questionnaire or medical record

follow-back were coded using.. "

Bias

Describe any efforts to

address potential sources of
bias

Study size

Explain how the study size

was arrived at

Yes

(halaman 3&4) Dijelaskan pada

bagian Breast Cancer Case
Ascertainment
" we first obtained self (or proxy)
report of a cancer.... We then
conducted medical record followback... We also linked the incidence
cohort to cancer registries in six
states... We searched death
certificates.. All cancer diagnoses
obtained from the questionnaire or
medical record follow-back.."

Quantitative
variables

Explain how quantitative

variables were handled in
the analyses. If applicable,
describe which groupings
were chosen and why

Statistical methods

(a) Describe all statistical

methods, including those
used to control for
confounding

(b) Describe any methods

used to examine subgroups
and interactions

(c) Explain how missing

data were addressed

(d) Cohort studyIf

applicable, explain how
loss to follow-up was
addressed

Case-control studyIf
applicable, explain how
matching of cases and
controls was addressed

Cross-sectional studyIf
applicable, describe
analytical methods taking
account of sampling
strategy
(e) Describe any sensitivity
analyses

(a) Report numbers of

individuals at each stage of
studyeg numbers
potentially eligible,
examined for eligibility,
confirmed eligible,
included in the study,
completing follow-up, and
analysed

Yes

(b) Give reasons for nonparticipation at each stage

No

(c) Consider use of a flow

diagram

No

(a) Give characteristics of

study participants (eg
demographic, clinical,
social) and information on
exposures and potential
confounders

(b) Indicate number of

participants with missing
data for each variable of
interest

(c) Cohort study

Summarise follow-up time
(eg, average and total
amount)

Cohort studyReport
numbers of outcome events
or summary measures over
time

Yes

Results
Participants

Descriptive data

Outcome data

Case-control studyReport numbers in each exposure

(halaman 7) Dijelaskan pada bagian

Results paragraf pertama We
observed 344 first primary breast
cancers in the cohort.. beginning
follow-up in 1970 ... the total number
of breast cancers included in this
analysis was 343 ... incidence of
breast cancer in the cohort was 37%
higher .."

(halaman 15) tabel AI sampai AIII

category, or summary
measures of exposure
Cross-sectional study
Report numbers of outcome
events or summary
measures
Main results

(a) Give unadjusted

estimates and, if applicable,
confounder-adjusted
estimates and their
precision (eg, 95%
confidence interval). Make
clear which confounders
were adjusted for and why
they were included

Yes

( halaman 6&12) Dijelaskan pada

bagian Results the overall cohort
and for each potential confounder....
consider a wider range of potential
confounders and effect modifiers.."

(b) Report category

boundaries when
continuous variables were
categorized
(c) If relevant, consider
translating estimates of
relative risk into absolute
risk for a meaningful time
period
Other analyses

Report other analyses done

eg analyses of subgroups
and interactions, and
sensitivity analyses

Key results

Summarise key results with

reference to study
objectives

Yes

(halaman 13) Dijelaskan pada bagian

Conclusions This large study of
breast cancer incidence in a cohort of
U.S. flight attendants.... breast cancer
incidence was not related to cosmic
radiation two metrics of circadian
rhythm disruption.. explained by
differences in parity and age at first
birth.."

Limitations

Discuss limitations of the

study, taking into account
sources of potential bias or
imprecision. Discuss both
direction and magnitude of

Yes

(halaman 11) Dijelaskan pada bagian

Limitations of the study " This
cohort of flight attendants had low
estimated cumulative cosmic

any potential bias

Interpretation

Give a cautious overall

interpretation of results
considering objectives,
limitations, multiplicity of
analyses, results from
similar studies, and other
relevant evidence

Generalisability

Discuss the generalisability

(external validity) of the
study results

Funding

Give the source of funding

and the role of the funders
for the present study and, if
applicable, for the original
study on which the present
article is based

radiation absorbed dose... An

additional limitation is that the four
primary occupational exposure
metrics..."
Yes

( halaman 11)
" Contrary to previous studies that
used estimated effective dose.. This
is supported by recent studies of
empirical microdosimetry

Yes

(halaman 2) Dijelaskan pada bagian

Materials and Method "This study
was conducted under the review and
approval of the Institutional Review
Boards of the National Institute for
Occupational Safety and Health and
the National Cancer Institut.."