The causal role of human papillomavirus infections in cervical cancer has been documented beyond reasonable doubt. The association is present in virtually all cervical cancer cases worldwide. It is the right time for medical societies and public health regulators to consider this evidence and to define its preventive and clinical implications. A comprehensive review of key studies and results is presented.

https://jcp.bmj.com/content/jclinpath/55/4/244.full.pdf

The causal relation between human papillomavirus and cervical cancer

Approximately 200 studies that examined the relationship between fruit and vegetable intake and cancers of the lung, colon, breast, cervix, esophagus, oral cavity, stomach, bladder, pancreas, and ovary are reviewed. A statistically significant protective effect of fruit and vegetable consumption was found in 128 of 156 dietary studies in which results were expressed in terms of relative risk. For most cancer sites, persons with low fruit and vegetable intake (at least the lower one-fourth of the population) experience about twice the risk of cancer compared with those with high intake, even after control for potentially confounding factors. For lung cancer, significant protection was found in 24 of 25 studies after control for smoking in most instances. Fruits, in particular, were significantly protective in cancers of the esophagus, oral cavity, and larynx, for which 28 of 29 studies were significant. Strong evidence of a protective effect of fruit and vegetable consumption was seen in cancers of the pancreas and stomach (26 of 30 studies), as well as in colorectal and bladder cancers (23 of 38 studies). For cancers of the cervix, ovary, and endometrium, a significant protective effect was shown in 11 of 13 studies, and for breast cancer a protective effect was found to be strong and consistent in a meta analysis. It would appear that major public health benefits could be achieved by substantially increasing consumption of these foods.

Fruit, vegetables, and cancer prevention: A review of the epidemiological evidence

Pathology and genetics of tumours of the urinary system and male genital organs

Are oestrogens involved in falling sperm counts and disorders of the male reproductive tract

Increasing interest in the health benefits of tea has led to the inclusion of tea extracts in dietary supplements and functional foods. However, epidemiologic evidence regarding the effects of tea consumption on cancer and cardiovascular disease risk is conflicting. While tea contains a number of bioactive chemicals, it is particularly rich in catechins, of which epigallocatechin gallate (EGCG) is the most abundant. Catechins and their derivatives are thought to contribute to the beneficial effects ascribed to tea. Tea catechins and polyphenols are effective scavengers of reactive oxygen species in vitro and may also function indirectly as antioxidants through their effects on transcription factors and enzyme activities. The fact that catechins are rapidly and extensively metabolized emphasizes the importance of demonstrating their antioxidant activity in vivo. In humans, modest transient increases in plasma antioxidant capacity have been demonstrated following the consumption of tea and green tea catechins. The effects of tea and green tea catechins on biomarkers of oxidative stress, especially oxidative DNA damage, appear very promising in animal models, but data on biomarkers of in vivo oxidative stress in humans are limited. Larger human studies examining the effects of tea and tea catechin intake on biomarkers of oxidative damage to lipids, proteins, and DNA are needed.

Tea catechins and polyphenols: health effects, metabolism, and antioxidant functions.

A population-based case-control study of 474 patients with cutaneous malignant melanoma and 926 population controls, conducted in East Denmark over a 3-year period, included an evaluation of the relationship of UV-light exposure to cutaneous melanoma risk. Patients with lentigo maligna melanoma were not included. Significantly increased risk was associated with severe sunburn before age 15 (RR = 2. 7 for 5 + vs. never), sunbathing (RR = 1. 6), boating (RR = 1. 4) and vacations spent in the sun (RR = 1. 4 for very sunny vs. never). A significant decrease in risk was associated with occupational exposure during the summer in males (RR = 0. 7), and no association with cutaneous microtopography was seen. These findings were independent of the effects of constitutional risk factors (naevi, freckles and light hair colour). No association was found between the risk of cutaneous melanoma and exposure to artificial UV-light (fluorescent light, sun lamps, or sun beds). No significant difference was found between superficial spreading melanoma and nodular melanoma with regard to any of the sun exposure variables. Our data indicate that exposure to intermittent intense sunlight is an important risk factor for cutaneous malignant melanoma, while long-term continuous exposure does not appear to be a risk factor for cutaneous malignant melanoma, while long-term continuous exposure does not appear to be a risk factor.

The Danish case-control study of cutaneous malignant melanoma. II. Importance of UV-light exposure.

Some 30 randomly selected men, aged 50–59 years, were in vestigated in each of 4 areas — Copenhagen, Them (rural Denmark), Helsinki, and Parikkala (rural Finland) — to determine the relationship of diet, gut transit time, fecal bulk, fecal bacteriology, bile acid concentration, and urinary volatile phenol production to large bowel cancer risk. Average daily fat intake was found to be high in all 4 areas, and no differences emerged between areas. Saturated fatty acid consumption was higher in low‐incidence areas than in high‐incidence areas. Intakes of nonstarch polysaccharides (the main component of dietary fiber), carbohydrate, and protein (mainly milk) were higher in the low‐incidence area of Parikkala than in the high‐incidence area of Copenhagen. The fecal bile acid concentration was higher in the high‐incidence area than in the low‐incidence area, with the other 2 areas having intermediate values. Fecal bulk showed an inverse association with colorectal cancer incidence. No differences were ...

Diet, bowel function, fecal characteristics, and large bowel cancer in Denmark and Finland

The relationship between cutaneous malignant melanoma and possible host factors was investigated in a population-based case-control study from East Denmark over a 3-year period. A total of 474 melanoma patients and 926 population controls aged 20-79 years were interviewed. Patients with lentigo maligna melanoma were not included. The major constitutional risk factors were: number of raised naevi on the arms (RR = 5.1 for 5+ vs. none), degree of freckling (RR = 2.9 for many vs. none), and light hair colour (RR = 1.7 for blond/fair vs. dark brown/black), which were independent of one another. An apparent synergy between number of raised naevi on the arms and degree of freckling was found. Thus, persons at high risk of melanoma may be identified by a simple assessment of naevi and degree of freckling. No significant difference was found between superficial spreading melanoma and nodular melanoma with regard to the most important host factors.

The Danish case-control study of cutaneous malignant melanoma. I. Importance of host factors.

Cancer morbidity and causes of death were examined in a retrospective cohort study of 14,313 male members of the Danish Brewery Workers' Union in order to determine health effects of heavy beer drinking, in particular in the aetiology of colorectal cancer. Brewery workers hold the right to consume 6 bottles (2,100 ml) of light pilsener beer (alcohol content 3.7 g1/00 ml) on the premises of the brewery per working day. The cohort included 1,063 mineral-water factory workers with no free ration of beer. Cancer morbidity and mortality were compared with those of the general population after adjustment for age, sex, area and time trends. Cancer morbidity, 1943–1972, was increased for cancer of the pharynx (RR = 2.09), oesophagus (RR=2.09), liver (RR=1.51) and larynx (RR = 1.98). The risk of these tumours was highest among workers who had had a ration of free beer during 30 or more years of employment. An increased risk of lung cancer (RR-1.16) corresponds with the risk among persons of low socio-economic class. These tumour sites accounted for a 9% excess of all malignant neoplasms among members of the BWU. No increased risk for either cancer of the colon (RR = 1.07) or cancer of the rectum (RR = 1.02) was observed. In contrast to studies on “alcoholics”, only deaths from the above-mentioned cancers, liver cirrhosis (RR=1.77) and motor vehicle accidents (RR = 1.33) were in excess; total mortality was only slightly above expectation (RR = 1.06). The present investigation suggests that the statistical association between beer and colo-rectal cancer is of a non-causal nature. It is concluded that the heavy consumption of “weak” alcoholic beverages may increase the risk of upper aero-digestive tract cancers, and that part of the disease pattern associated with “alcoholism” is unrelated to alcohol consumption.

Ole M. Jensen

Papers

The Danish case-control study of cutaneous malignant melanoma. II. Importance of UV-light exposure.

Diet, bowel function, fecal characteristics, and large bowel cancer in Denmark and Finland

The Danish case-control study of cutaneous malignant melanoma. I. Importance of host factors.

Cancer morbidity and causes of death among Danish brewery workers

Cancer morbidity and causes of death among danish brewery workers