Estimates of the worldwide incidence, mortality and prevalence of 26 cancers in the year 2002 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. The results are presented here in summary form, including the geographic variation between 20 large "areas" of the world. Overall, there were 10.9 million new cases, 6.7 million deaths, and 24.6 million persons alive with cancer (within three years of diagnosis). The most commonly diagnosed cancers are lung (1.35 million), breast (1.15 million), and colorectal (1 million); the most common causes of cancer death are lung cancer (1.18 million deaths), stomach cancer (700,000 deaths), and liver cancer (598,000 deaths). The most prevalent cancer in the world is breast cancer (4.4 million survivors up to 5 years following diagnosis). There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors related to lifestyle or environment, and provides a clear challenge to prevention.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.55.2.74

Global cancer statistics, 2002.

background The influence of excess body weight on the risk of death from cancer has not been fully characterized. methods In a prospectively studied population of more than 900,000 U.S. adults (404,576 men and 495,477 women) who were free of cancer at enrollment in 1982, there were 57,145 deaths from cancer during 16 years of follow-up. We examined the relation in men and women between the body-mass index in 1982 and the risk of death from all cancers and from cancers at individual sites, while controlling for other risk factors in multivariate proportional-hazards models. We calculated the proportion of all deaths from cancer that was attributable to overweight and obesity in the U.S. population on the basis of risk estimates from the current study and national estimates of the prevalence of overweight and obesity in the U.S. adult population. results The heaviest members of this cohort (those with a body-mass index [the weight in kilograms divided by the square of the height in meters] of at least 40) had death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight. For men, the relative risk of death was 1.52 (95 percent confidence interval, 1.13 to 2.05); for women, the relative risk was 1.62 (95 percent confidence interval, 1.40 to 1.87). In both men and women, body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney; the same was true for death due to non-Hodgkin’s lymphoma and multiple myeloma. Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women. On the basis of associations observed in this study, we estimate that current patterns of overweight and obesity in the United States could account for 14 percent of all deaths from cancer in men and 20 percent of those in women. conclusions Increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites.

/pdf/overweight-obesity-and-mortality-from-cancer-in-a-3whc0l70ow.pdf

Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults.

The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Hepatocellular Carcinoma: Epidemiology and Molecular Carcinogenesis

CA : A Cancer Journal for Clinicians

Iron is an essential mineral to all human tissues. Incorporated in the heme complex, it is necessary for the hemoglobin-borne transport of oxygen and generation of ATP in the electron transport chain. But iron may also have direct toxic effects, and iron uptake is con- sequentially tightly regulated in the human body ( 1 ). Recognizing the pro-oxidative properties of iron and its tendency to accumulate with age in properly nourished individuals, investigators have hypothesized that iron might be involved in the causation of many of the chronic diseases that are linked to a Western lifestyle ( 2 - 4 ), and believers have coined the term "ferrotoxic" disease ( 5 ). For example, sex differences in iron levels have been hypothesized to contribute to the differences between men and women in the risk of cardiovascular disease ( 6 ). visceral cancer occurrence (hazard ratio (HR) = 0.65, 95% confi dence interval (CI) = 0.43 to 0.97; P = .036) than the 641 patients in the control arm. Patients who developed cancer in the iron reduction group had higher mean ferritin levels across all follow-up visits than those in the same intervention arm who did not develop cancer, suggesting that the treatment advantage could have been even bigger if compliance had been better. Furthermore, the 38 iron-reduced patients who developed cancer during follow-up had lower risks of death from cancer (HR = 0.39, 95% CI = 0.21 to 0.72; P = .003) and all-cause mortality (HR = 0.49, 95% CI = 0.29 to 0.83; P = .009) in the fairly short period that passed between cancer diagnosis and end of follow-up than the 60 control patients who were also diagnosed with cancer. Zacharski et al. ( 14) should be congratulated on their efforts. Their trial is both innovative and well executed; its only major limitation is that it was not designed to study cancer as the outcome and that the present report is based on an ad hoc analysis. This could have been a serious threat to the validity of the conclusions if the investigators had dredged data for many specifi c outcomes or combinations of outcomes. In this case, however, it seems as if the cancer analyses were second on the list after cardiovascular out- comes, and the authors commendably restricted themselves to only one aspect, namely incidence of total visceral cancer. It is not clear, however, what is meant by "visceral" cancer and why the authors chose this as the outcome and not total cancer. Are the fi ndings biologically plausible? Strikingly, cumulative risk curves for the intervention and control groups began to sepa- rate at 6 months, ie, after only one phlebotomy. In fact, almost all the effects observed in the present study between the phlebotomy arm and control arm regarding cumulative incidence were seen within the fi rst 2 years of entry to the study. The authors speculate that late-stage effects of iron depletion on already established tumors might be prominent, but we remain skeptical. The observed risk difference is unexpected in terms of both timing and magnitude. Moreover, although a higher proportion of lung can- cers in the control group may partly explain the observed marked advantage for iron-depleted vs nondepleted cancer patients as far as cancer-specifi c and all-cause mortality is concerned, there are

/pdf/cancer-as-a-ferrotoxic-disease-are-we-getting-hard-stainless-49y728rqfe.pdf

Cancer as a Ferrotoxic Disease: Are We Getting Hard Stainless Evidence?

The authors aimed to evaluate the web and an Interactive Voice Response (IVR) phone service as vehicles in population-based infectious disease surveillance. Fourteen thousand subjects were randomly selected from the Swedish population register and asked to prospectively report all respiratory tract infections, including Influenza-like Illness (ILI—clinical symptoms indicative of influenza but no laboratory confirmation), immediately as they occurred during a 36-week period starting October 2007. Participants were classified as belonging to the web or IVR group based on their choice of technology for initial registration. In all, 1,297 individuals registered via IVR while 2,044 chose the web. The latter were more often young and well-educated than those registered via IVR. Overall, 52% of the participants reported at least one infection episode. The risk of an infectious disease report was 14% (95% CI: 6, 22%) higher in the web group than in the IVR group. For ILI the excess was 27% (95% CI: 11, 47%). After adjustments for socio-demographic factors, statistically non-significant excesses of 1 and 8% remained, indicating trivial differences potentially attributable to the two reporting techniques. With attention to confounding, it should be possible to combine the web and IVR for simple reporting of infectious disease symptoms.

/pdf/interactive-voice-response-and-web-based-questionnaires-for-218h66mim5.pdf

Interactive Voice Response and web-based questionnaires for population-based infectious disease reporting

BACKGROUND—Previous reports have indicated an association between Barrett's metaplasia or adenocarcinoma of the oesophagus and colonic neoplasia, but the findings have been inconsistent. If true, such an association suggests common causal mechanisms.
AIMS—To test the hypothesis of an association between Barrett's metaplasia or adenocarcinoma of the oesophagus and colonic neoplasia.
METHODS—A population based, retrospective cohort study was performed on all Swedish patients with colon cancer diagnosed between 1958 and 1992. 538 500 person years at risk were reviewed among the 118 030 patients in the cohort (average follow up 4.6 years, median 2.1 years). The standardised incidence ratio (SIR), the ratio of the observed to the expected number of incident oesophageal adenocarcinomas, was used as a measure of relative risk. The expected number was derived from the entire Swedish population.
RESULTS—Eleven oesophageal adenocarcinomas were found during follow up in the cohort, as against 9.5 expected (SIR=1.2; 95% confidence interval 0.6-2.1). Analysis by latency intervals after diagnosis of colon cancer showed no trend towards increasing or decreasing risk over time. There were no important sex differences in relative risk.
CONCLUSIONS—Results provide no support for a common link between colon cancer and oesophageal adenocarcinoma. Although the direct relation between colon cancer and Barrett's oesophagus was not looked at, a search for common aetiological factors or genetic defects may not be fruitful. Screening for colonic neoplasia among patients with malignant or premalignant oesophageal mucosa, or vice versa, may not be warranted.


Keywords: oesophageal cancer; Barrett's metaplasia; colon cancer; adenocarcinoma

https://gut.bmj.com/content/gutjnl/44/6/819.full.pdf

No association between colon cancer and adenocarcinoma of the oesophagus in a population based cohort study in Sweden

Demographic epidemiology, current drug therapy and the health care resources required by patients clinically considered to have gastritis were studied during a four and a half year period-October 1978 to March 1983. The investigation was based on data from the Diagnosis and Therapy Survey, an on-going nation-wide sample study covering all out-patient care in Sweden. Gastritis was found to account for 1.9% of all out-patient consultations and for 30% of those for gastrointestinal disorders. The corresponding figures for peptic ulcer disease were 0.2 % and 4%, respectively. The estimated minimum number of annual consultations for gastritis was 47 per 1,000 inhabitants. The majority of the consultations were dealt with in general practice, where gastritis was the fifth most common diagnosis. Drug therapy was considered to be indicated in 92% of the consultations. Antacids were prescribed in 77%, anticholinergic/spasmolytic drugs in 36% and bistamine H2-receptor antagonists in 4%. The clinical diagnosis of ga...

The Diagnosis and Therapy Survey October 1978-March 1983, health care consumption and current drug therapy in Sweden with respect to the clinical diagnosis of gastritis.

Case reports have suggested that children born to women with silicone breast implants may have an excess risk of rheumatic disease and/or esophageal disorders. In Sweden, the authors conducted a retrospective cohort study of 5,874 children born to women with cosmetic breast implants and 13,274 children born to women who had breast reduction surgery. Using national registers, they computed hospitalization rates for rheumatic and esophageal disorders, incidence rates for cancer, and prevalence rates for congenital malformations and perinatal death. Relative to children of women who had breast reduction surgery, children born to women who had cosmetic breast implants were not at excess risk of rheumatic disease (relative risk [RR] = 1.1; 95% confidence interval [95% CI], 0.2-5.3), esophageal disorders (RR = 1.0; 95% CI, 0.7-1.6), cancer (RR = 0.3; 95% CI, 0.0-2.5), congenital malformations in total (RR = 1.0; 95% CI, 0.6-1.5), or specifically involving the digestive organs (RR = 0.5; 95% CI, 0.2-1.3) or perinatal death (RR = 0.9; 95% CI, 0.5-1.8). The rates of these health outcomes among children born after a mother's implant surgery were also not significantly higher than among children born before a mother's implant surgery. This study provides no evidence that certain hypothesized health outcomes are more likely among the children of women with cosmetic breast implants.

Olof Nyrén

Papers

Cancer as a Ferrotoxic Disease: Are We Getting Hard Stainless Evidence?

Interactive Voice Response and web-based questionnaires for population-based infectious disease reporting

No association between colon cancer and adenocarcinoma of the oesophagus in a population based cohort study in Sweden

The Diagnosis and Therapy Survey October 1978-March 1983, health care consumption and current drug therapy in Sweden with respect to the clinical diagnosis of gastritis.

Offspring health risk after cosmetic breast implantation in Sweden.