Showing papers by "Donald Maxwell Parkin published in 2011"

16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010.

Abstract: This chapter summarises the results of the preceding sections, which estimate the fraction of cancers occurring in the UK in 2010 that can be attributed to sub-optimal, past exposures of 14 lifestyle and environmental risk factors. For each of 18 cancer types, we present the percentage of cases attributable to one or all of the risk factors considered (tobacco, alcohol, four elements of diet (consumption of meat, fruit and vegetables, fibre, and salt), overweight, lack of physical exercise, occupation, infections, radiation (ionising and solar), use of hormones, and reproductive history (breast feeding)).Exposure to less than optimum levels of the 14 factors was responsible for 42.7% of cancers in the UK in 2010 (45.3% in men, 40.1% in women)--a total of about 134,000 cases.Tobacco smoking is by far the most important risk factor for cancer in the UK, responsible for 60, 000 cases (19.4% of all new cancer cases) in 2010. The relative importance of other exposures differs by sex. In men, deficient intake of fruits and vegetables (6.1%), occupational exposures (4.9%) and alcohol consumption (4.6%) are next in importance, while in women, it is overweight and obesity (because of the effect on breast cancer)--responsible for 6.9% of cancers, followed by infectious agents (3.7%).Population-attributable fractions provide a valuable quantitative appraisal of the impact of different factors in cancer causation, and are thus helpful in prioritising cancer control strategies. However, quantifying the likely impact of preventive interventions requires rather complex scenario modelling, including specification of realistically achievable population distributions of risk factors, and the timescale of change, as well as the latent periods between exposure and outcome, and the rate of change following modification in exposure level.

Cancer incidence in the United Kingdom: projections to the year 2030

Abstract: Projections of cancer incidence are important for planning health services and to provide a baseline for assessing the impact of public health interventions. Rates estimated from smooth function age–period–cohort modelling of cancer incidence data from Great Britain 1975 to 2007 are extrapolated to 2030 and applied to UK population projections. Prostate and breast cancer projections take into account the effect of screening. Overall rates of cancer are projected to be stable over the next 20 years, but this masks individual changes. In both sexes, age-standardised rates of cancers of the stomach, larynx, bladder and leukaemia are projected to fall by ⩾1% per year, whereas cancers of the lip, mouth and pharynx (ICD-10 C00-C14) and melanoma are projected to increase by ⩾1% per year. The growing and aging populations will have a substantial impact: numbers of cancers in men and women are projected to increase by 55% (from 149 169 to 231 026) and 35% (from 148 716 to 200 929), respectively, between 2007 and 2030. The model used yields similar results to those of Nordpred, but is more flexible. Without new initiatives for smoking and obesity reduction, the number of cancers in the United Kingdom will increase substantially reflecting the growing and aging populations.

13. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010.

Abstract: 13. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010

2. Tobacco-attributable cancer burden in the UK in 2010

Abstract: Table 7 summarizes the findings with respect to lung cancer and exposure to tobacco smoke. In total, 34 599 cases of lung cancer in the UK (86% of the total) were due to exposure to tobacco smoke in 2010, the great majority of which (97.4%) are due to active smoking (current or in the past). The figures for men are 87% cases due to exposure to tobacco (of which 97.7% were due to smoking), and for women 84% cases due to exposure to tobacco (of which 96.2% were due to smoking). Table 7 Cases of lung cancer attributable to tobacco, by sex and age group (UK 2010) Table 8 shows the final summary of the estimate of tobacco-attributable cancer in the UK. In total, the estimate is of 60 837 cancer cases (19.4% of all new cancer cases) attributable to tobacco: 36 537 (23.0%) of cancers in men and 24 300 (15.6%) of cancers in women. Table 8 Cancer cases caused by exposure to tobacco smoke (by smoking, or environmental), UK 2010 See acknowledgements on page Si.

3. Cancers attributable to consumption of alcohol in the UK in 2010

Abstract: In 1988, the International Agency for Research on Cancer (IARC) Monograph on the carcinogenic risk to humans of alcohol drinking concluded that the occurrence of malignant tumours of the oral cavity, pharynx, larynx, oesophagus and liver was causally related to the consumption of alcoholic beverages. In an updated review (Baan et al, 2007; Secretan et al, 2009), they noted the consistent finding of an increased risk of breast cancer with increasing alcohol intake, and that an association between alcohol consumption and colorectal cancer had been reported by more than 50 prospective and case–control studies, with no difference in the risk for colon and rectal cancers (Baan et al, 2007). The World Cancer Research Fund report (WCRF, 2007) considered that the evidence for an association of alcohol intake with these sites was convincing and, for liver cancer, probable.

8. Cancers attributable to overweight and obesity in the UK in 2010.

Abstract: In 2002, the International Agency for Research on Cancer Handbook on Weight Control and Physical Activity concluded that overweight and obesity are related to cancers of the colon, endometrium, kidney and oesophagus (adenocarcinomas), as well as postmenopausal breast cancer Since that report, continuing epidemiological investigation has suggested that other cancers are related to obesity and overweight In addition to those listed above, the report by the World Cancer Research Fund (WCRF) Panel on Food, Nutrition, Physical Activity, and the Prevention of Cancer (WCRF, 2007) considered that there was convincing evidence for an association with cancers of the pancreas and rectum (as well as colon), and a probable association with cancers of the gall bladder The fraction of these cancers occurring in 2010 attributable to overweight and obesity in the UK population is estimated in this section

11. Cancers attributable to infection in the UK in 2010

Abstract: The infectious agents that have been identified as definitely or probably carcinogenic to humans (Groups 1 and 2A) in the International Agency for Research on Cancer (IARC) monograph series are shown in Table 1. They include hepatitis B (HBV) and C (HCV) viruses, human papillomaviruses (HPV), human immunodeficiency virus (HIV) and T-lymphotropic virus type-1 (HTLV-1), Epstein–Barr virus (EBV) and human herpesvirus 8 (HHV8), and the bacterium Helicobacter pylori.

9. Cancers attributable to inadequate physical exercise in the UK in 2010

Abstract: 9. Cancers attributable to inadequate physical exercise in the UK in 2010

12. Cancers in 2010 attributable to ionising radiation exposure in the UK

Abstract: The hazards of exposure to some types of ionising radiation were recognized shortly after the discovery of the X-ray in 1895: by 1902 the first radiation-associated cancer was reported in a skin sore and, within a few years, a large number of such skin cancers had been observed. The first report of leukaemia in radiation workers appeared in 1911. Since then there have been many reviews of the health effects of ionising radiation, most notably in the reports of the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) (see, for example, UNSCEAR, 2006). The International Agency for Research on Cancer's Monographs on the Carcinogenic Risk to Humans also reviewed the effects of ionising radiation, both in the form of exposure to external γ or X-rays (IARC, 2000) and as α and β particles from internalised radionuclides (IARC, 2001), and all these types of radiation were classified as carcinogenic to humans.

The cancer burden in the United Kingdom in 2007 due to radiotherapy.

Abstract: The number of long-term cancer survivors in the general population of the UK is substantial and increasing rapidly. Many cancer survivors have been treated with radiotherapy but the likely number of radiotherapy-related second cancers has not previously been estimated. We used estimates of the numbers of cancer survivors in the UK at the beginning of 2007, in conjunction with estimates of the relative risk of a second primary cancer associated with previous radiotherapy from the United States Surveillance Epidemiology and End Results (SEER) programme, to estimate the numbers of incident cancers in the UK in 2007 that were associated with radiotherapy for a previous cancer and that may have been caused by it. We estimated that 1,346 cases of cancer, or about 0.45% of the 298,000 new cancers registered in the UK in 2007, were associated with radiotherapy for a previous cancer. The largest numbers of radiotherapy-related second cancers were lung cancer (23.7% of the total), oesophageal cancer (13.3%), and female breast cancer (10.6%); 54% of radiotherapy-related second cancers were in individuals aged 75 or over. The highest percentages of second cancers related to radiotherapy were among survivors of Hodgkin's disease and cancers of the oral cavity and pharynx and cervix uteri; over 15% of second cancers among these survivors were associated with radiotherapy for the first cancer. These calculations, which involve a number of assumptions and approximations, provide a reasonable, if conservative, estimate of the fraction of incident cancers in the UK that are attributable to past radiation therapy.

10. Cancers attributable to exposure to hormones in the UK in 2010

Abstract: The International Agency for Research on Cancer (IARC) Monographs on the carcinogenic risk to humans concluded that combined oral oestrogen–progestogen contraceptives are carcinogenic to humans (IARC, 2007). This evaluation was made on the basis of increased risks for cancer of the breast (among current and recent users only), cervix and liver (in populations that are at low risk for hepatitis B viral infection). There is also convincing evidence in humans that these agents confer a protective effect against cancer of the endometrium and ovary.

15. Cancers attributable to reproductive factors in the UK in 2010.

Abstract: Reproductive factors influence the risk of cancers of the female genital tract (uterus and ovary) and breast. The following reproductive factors are important in this respect: age at menarche; age at first birth; parity; age at menopause; and duration of breastfeeding. The effects of exogenous hormones are described in Section 10.

14. Cancers attributable to occupational exposures in the UK in 2010

Abstract: The International Agency for Research on Cancer (IARC, 2010a) has classified 107 agents, mixtures or exposure circumstances as Group 1 (carcinogenic to humans), many of which are encountered in occupational settings, for example, asbestos and cadmium. An additional 58 agents, mixtures or exposure circumstances have been classified as Group 2A (probably carcinogenic to humans). Those with occupational significance include diesel fumes and benzidine-based dyes (IARC, 2010a). Table 1 (adapted from Siemiatycki et al, 2004) shows the most important occupational exposures in these two categories. Table 1 Occupational exposures linked to cancer risk and industries in which exposures can occur A comprehensive analysis of occupational exposures, with quantitative estimates of the cancers attributable to them, has been carried out by Imperial College London and the Health and Safety Laboratory on behalf of the Health & Safety Executive by Rushton et al (2007). This analysis has been updated and extended, based on mortality in Britain in 2005 and incidence in 2004 (Rushton et al, 2010). Here, we have applied the population-attributable fractions (PAFs) for Great Britain, as estimated in this paper, to the estimated cancer incidence in UK in 2010.

6. Cancers attributable to dietary factors in the UK in 2010. III. Low consumption of fibre.

Abstract: Dietary fibre has long been thought to be associated with a reduced risk of colorectal cancer (Burkitt, 1971). However, analytic epidemiological studies of dietary fibre and the risk of colorectal cancer have not yielded consistent associations. The first comprehensive meta-analysis of prospective studies showed no significant reduction in the risk of colorectal cancer with high consumption of fibre, but very low fibre intake (less than 10 g per day) did significantly increase bowel cancer risk (Park et al, 2005). The results of subsequent cohort studies seem to be split between those suggesting a protective effect of fibre (Bingham et al, 2003, 2005; Nomura et al, 2007; Wakai et al, 2007) and those showing no benefit (Otani et al, 2006; Shin et al, 2006). In some studies, null findings may be due to an insufficient range of fibre intake or other methodological problems; alternatively, other features of a high-fibre diet (a plant-based diet rich in fruits, vegetables and whole grains) could be responsible for the protective effect. The World Cancer Research Fund (WCRF) review (2007) concluded that, although there was a clear association, residual confounding could not be excluded as an explanation for the dose–response relationship between risk and fibre intake. In a subsequent study combining data from seven UK cohort studies (Dahm et al, 2010), fibre intake was ascertained by food diaries (rather than the less reliable food frequency questionnaires used in most studies), and issues of confounding (by anthropometric and socioeconomic factors, and dietary intake of folate, alcohol and energy) were addressed. A clear protective effect of fibre intake was observed, with a risk of colorectal cancer of 0.66 in the highest relative to the lowest quintile of intake.

7. Cancers attributable to dietary factors in the UK in 2010. IV. Salt.

Abstract: In a large international ecological study, comparing urinary sodium excretion and stomach cancer mortality in 39 countries, Joossens et al (1996) concluded that ‘Salt intake, measured as 24-hour urine sodium excretion, is likely the rate-limiting factor of stomach cancer mortality at the population level'. On the basis of human observational and animal experimental data, as well as mechanistic plausibility, the 2003 report from the joint World Health Organization/Food and Agriculture Organization Expert Consultation (WHO/FAO) concluded that salt-preserved food and salt ‘probably' increase the risk of gastric cancer (WHO/FAO, 2003). In fact, there is substantial evidence that the risk of gastric cancer is increased by high intakes of some traditionally preserved salted foods, especially meats and pickles, and with salt per se (Palli, 2000; Tsugane, 2005). The World Cancer Research Fund (WCRF) report (2007) concluded that ‘salt is a probable cause of stomach cancer', and that there is robust evidence for the mechanisms operating in humans. In the UK, the Committee on Medical Aspects of Food Policy (COMA) panel on Dietary Reference Values (Department of Health, 1991) advised that sodium (Na) intakes should be maintained below 3.2 g (or 8.0 g of salt) per day and set the reference nutrient intake (RNI) for men and women at 1.6 g of sodium (or 4.0 g of salt) per day. Following this, COMA's Cardiovascular Review Group recommended that salt intake should be gradually reduced further to a daily average of 6 g (Department of Health, 1994). This recommendation was also accepted in the food and health action plan ‘Choosing a better diet' (Department of Health, 2005). In this section, we consider the population-attributable fraction of stomach cancer associated with an intake of salt >6 g per day.

4. Cancers attributable to dietary factors in the UK in 2010: I. Low consumption of fruit and vegetables

Abstract: There is considerable controversy over the protective effect of diets rich in fruit, vegetables and fibre, and the respective roles of the different components (including micronutrients such as folate). The report of the Committee on Medical Aspects of Food Nutrition Policy (COMA) (Department of Health, 1998) recommended increasing consumption of all of them, an advice that seems to have motivated the Department of Health in promoting its ‘5-a-day’ programme (Department of Health, 2005). The original consensus of the probable decrease in risk of several cancers of the gastrointestinal tract (oral cavity and pharynx, oesophagus, stomach and colorectum) associated with increased consumption of fruit and vegetables (WHO/FAO, 2003) was based on the results of multiple case–control studies and a few prospective studies. The IARC Handbook of Cancer Prevention (IARC, 2003) concludes its review of the evidence as follows: There is limited evidence for cancer-preventive effect of consumption of fruit and vegetables for cancers of the mouth and pharynx, oesophagus, stomach, colorectum, larynx, lung, ovary (vegetables only), bladder (fruit only) and kidney. There is inadequate evidence for a cancer-preventive effect of consumption of fruit and vegetables for all other sites. More specifically, this evidence indicates that higher intake of fruit probably lowers the risk of cancers of the oesophagus, stomach and lung, while higher intake of vegetables probably lowers the risk of cancers of the oesophagus and colorectum. Likewise a higher intake of fruit possibly lowers the risk of cancers of the mouth, pharynx, colorectum, larynx, kidney and urinary bladder. An increase in consumption of vegetables possibly reduces the risk of cancers of the mouth, pharynx, stomach, larynx, lung, ovary and kidney.

Cancer survival in Kampala, Uganda, 1993-1997.

Abstract: The Kampala cancer registry was established in 1954 as a population-based cancer registry, and registration of cases is done by active methods. The registry contributed data on survival for 15 cancer sites or types registered in 1993-1997. For Kaposi sarcoma, only a random sample of the total incident cases was provided for survival study. Follow-up has been carried out predominantly by active methods, with median follow-up ranging from 4-26 months. The proportion with histologically verified diagnosis for various cancers ranged between 36-83%; death certificate only (DCO) cases were negligible; 58-92% of total registered cases were included for survival analysis. Complete follow-up at five years ranged between 47-87% for different cancers. Five-year age-standardized relative survival rates for selected cancers were Kaposi sarcoma (22%), cervix (19%), oesophagus (5%), non-Hodgkin lymphoma (26%), breast (36%) and prostate (46%). None survived beyond 5 years for cancers of the stomach and lung. Five-year relative survival by age group was fluctuating with no definite pattern or trend emerging and no survivors in many age intervals.

MTHFR polymorphisms and Opisthorchis viverrini infection: a relationship with increased susceptibility to cholangiocarcinoma in Thailand.

Abstract: Opisthorchis viverrini (OV) infection is the major risk factor for cholangiocarcinoma (CCA). Methylenetetrahydrofolate reductase (MTHFR) is an important enzyme in folate metabolism. Change in MTHFR activity may influence both DNA methylation and synthesis, crucial steps in carcinogenesis. This study aimed to investigate the association between MTHFR polymorphisms and OV infection with CCA risk in a high-incidence area of Thailand. A nested case-control study within cohort study was carried out: 219 subjects with primary CCA were matched with two non-cancer controls from the same cohort on sex, age at recruitment and presence/ absence of OV eggs in stool. At the time of recruitment information on consumption of foodstuffs potentially contaminated by OV was obtained by questionnaire. MTHFR polymorphisms were analyzed using PCR with high resolution melting analysis. Associations between variables and the risk of CCA were assessed using conditional logistic regression. Risk of CCA was related to consumption of a dish of raw freshwater fish (KoiPla) with clear dose-response effects, and there were joint effects on CCA risk between MTHFR polymorphisms and consumption of dishes containing raw- and/or semi-raw freshwater fish. This study provides evidence to support a relationship of increased susceptibility to CCA in individuals with MTHFR variants, especially for those individuals who have OV infection or consume semi-raw freshwater fish (acting either as a source of OV or of pre-formed nitrosamine). Folate may play an important role in OV-related cholangiocarcinogenesis by upsetting the balance between DNA methylation and synthesis in the folate pathway.

Cancer survival in Harare, Zimbabwe, 1993-1997.

Abstract: The Zimbabwe national cancer registry was established in 1985 as a population-based cancer registry covering Harare city. Cancer is not a notifiable disease, and registration of cases is done by active methods. The registry contributed data on randomly drawn sub-samples of Harare resident cases among 17 common cancer sites or types registered during 1993-1997 from black and white populations. Follow-up was carried out predominantly by active methods with median follow-up ranging from 1-54 months for different cancers. The proportion with histologically verified diagnosis for various cancers ranged from 20-100%; death certificate only (DCO) cases comprised 0-34%; 58-97% of total registered cases were included for survival analysis. Complete follow-up at five years ranged from 94-100%. Five-year age-standardized relative survival rates of selected cancers among both races combined were cervix (42%), breast (68%), Kaposi sarcoma (4%), liver (3%), oesophagus (12%), stomach (20%) and lung (14%). Survival was markedly higher among white than black populations for most cancers with adequate cases. Five-year relative survival by age group was fluctuating, with no definite pattern or trend.

Author's reply to: Lung cancer mortality in sub-Saharan Africa

Abstract: Dear Editor, In a recent paper in the IJC, Ferlay et al. report on the results of the latest update of GLOBOCAN, released on 1st June 2010 by the International Agency for Research on Cancer. GLOBOCAN 2008 is an important resource for cancer research and health policy. Mortality and incidence estimates of crude rates, age-standardized rates and absolute number of cases by country and sex for the year 2008 are provided. We agree with their conclusion that ‘‘Already the majority of the global cancer burden now occurs in developing countries, these proportions will rise in the next decades if rates remain unchanged.’’ Given the demographic transition that is ongoing in developing countries, the absolute numbers will almost certainly rise in the future. In Sub-Saharan Africa (SSA), population-based data on lung cancer incidence or mortality are not available, except South Africa and smaller island states. GLOBOCAN uses