Showing papers by "Cancer Epidemiology Unit published in 2009"
TL;DR: Low to moderate alcohol consumption in women increases the risk of certain cancers, and increasing levels of alcohol consumption were associated with a decreased risk of thyroid cancer, non-Hodgkin lymphoma, and renal cell carcinoma.
Abstract: increased risks of cancers of the oral cavity and pharynx (increase per 10 g/d = 29%, 95% CI = 14% to 45%, P trend < .001), esophagus (22%, 95% CI = 8% to 38%, P trend = .002), larynx (44%, 95% CI = 10% to 88%, P trend = .008), rectum (10%, 95% CI = 2% to 18%, P trend = .02), liver (24%, 95% CI = 2% to 51%, P trend = .03), breast (12%, 95% CI = 9% to 14%, P trend < .001), and total cancer (6%, 95% CI = 4% to 7%, P trend < .001). The trends were similar in women who drank wine exclusively and other consumers of alcohol. For cancers of the upper aerodigestive tract, the alcohol-associated risk was confined to current smokers, with little or no effect of alcohol among never and past smokers ( P heterogeneity < .001). Increasing levels of alcohol consumption were associated with a decreased risk of thyroid cancer ( P trend = .005), non – Hodgkin lymphoma ( P trend = .001), and renal cell carcinoma ( P trend = .03). Conclusions Low to moderate alcohol consumption in women increases the risk of certain cancers. For every additional drink regularly consumed per day, the increase in incidence up to age 75 years per 1000 for women in developed countries is estimated to be about 11 for breast cancer, 1 for cancers of the oral cavity and pharynx, 1 for cancer of the rectum, and 0.7 each for cancers of the esophagus, larynx and liver, giving a total excess of about 15 cancers per 1000 women up to age 75. J Natl Cancer Inst 2009;101: 296 – 305
557 citations
TL;DR: The risk of deep vein thrombosis and pulmonary embolism after surgery is substantially increased in the first 12 postoperative weeks, and varies considerably by type of surgery.
Abstract: Objective To examine the duration and magnitude of increased risk of venous thromboembolism after different types of surgery.
Design Prospective cohort study (Million Women Study).
Setting Questionnaire data from the Million Women Study linked with hospital admission and death records.
Participants 947 454 middle aged women in the United Kingdom recruited in 1996-2001 and followed by record linkage to routinely collected NHS data on hospital admissions and deaths. During follow-up 239 614 admissions were for surgery; 5419 women were admitted, and a further 270 died, from venous thromboembolism.
Main outcome measures Adjusted relative risks and standardised incidence rates for hospital admission or death from venous thromboembolism (pulmonary embolism or deep vein thrombosis), by time since and type of surgery.
Results Compared with not having surgery, women were 70 times more likely to be admitted with venous thromboembolism in the first six weeks after an inpatient operation (relative risk 69.1, 95% confidence interval 63.1 to 75.6) and 10 times more likely after a day case operation (9.6, 8.0 to 11.5). The risks were lower but still substantially increased 7-12 weeks after surgery (19.6, 16.6 to 23.1 and 5.5, 4.3 to 7.0, respectively). This pattern of risk was similar for pulmonary embolism (n=2487) and deep venous thrombosis (n=3529). The postoperative risks of venous thromboembolism varied considerably by surgery type, with highest relative risks after inpatient surgery for hip or knee replacement and for cancer—1-6 weeks after surgery the relative risks were, respectively, 220.6 (187.8 to 259.2) and 91.6 (73.9 to 113.4).
Conclusion The risk of deep vein thrombosis and pulmonary embolism after surgery is substantially increased in the first 12 postoperative weeks, and varies considerably by type of surgery. An estimated 1 in 140 middle aged women undergoing inpatient surgery in the UK will be admitted with venous thromboembolism during the 12 weeks after surgery (1 in 45 after hip or knee replacement and 1 in 85 after surgery for cancer), compared with 1 in 815 after day case surgery and only 1 in 6200 women during a 12 week period without surgery.
356 citations
TL;DR: Investigation of women’s reported use of breast and cervical screening and sociodemographic characteristics found indicators of wealth were important for breast screening and ethnicity for cervical screening, but some inequalities exist in the reportedUse of screening.
Abstract: Objective To investigate the relation between women’s reported use of breast and cervical screening and sociodemographic characteristics.
Design Cross sectional multipurpose survey.
Setting Private households, Great Britain.
Population 3185 women aged 40-74 interviewed in the National Statistics Omnibus Survey 2005-7.
Main outcome measures Ever had a mammogram, ever had a cervical smear, and, for each, timing of most recent screen.
Results 91% (95% confidence interval 90% to 92%) of women aged 40-74 years reported ever having had a cervical smear, and 93% (92% to 94%) of those aged 53-74 years reported ever having had a mammogram; 3% (2% to 4%) of women aged 53-74 years had never had either breast or cervical screening. Women were significantly more likely to have had a mammogram if they lived in households with cars (compared with no car: one car, odds ratio 1.67, 95% confidence interval 1.06 to 2.62; two or more cars, odds ratio 2.65, 1.34 to 5.26), and in owner occupied housing (compared with rented housing: own with mortgage, odds ratio 2.12, 1.12 to 4.00; own outright, odds ratio 2.19, 1.39 to 3.43), but no significant differences by ethnicity, education, occupation, or region were found. For cervical screening, ethnicity was the most important predictor; white British women were significantly more likely to have had a cervical smear than were women of other ethnicity (odds ratio 2.20, 1.41 to 3.42). Uptake of cervical screening was greater among more educated women but was not significantly associated with cars, housing tenure, or region.
Conclusions Most (84%) eligible women report having had both breast and cervical screening, but 3% report never having had either. Some inequalities exist in the reported use of screening, which differ by screening type; indicators of wealth were important for breast screening and ethnicity for cervical screening. The routine collection within general practice of additional sociodemographic information would aid monitoring of inequalities in screening coverage and inform policies to correct them.
289 citations
TL;DR: A combination of public education about symptoms and empowerment to seek medical advice, as well as support at primary care level, could enhance early presentation and improve cancer outcomes.
Abstract: To assess public awareness of cancer warning signs, anticipated delay and perceived barriers to seeking medical advice in the British population. We carried out a population-based survey using face-to-face, computer-assisted interviews to administer the cancer awareness measure (CAM), a newly developed, validated measure of cancer awareness. The sample included 2216 adults (970 males and 1246 females) recruited as part of the Office for National Statistics Opinions Survey using stratified probability sampling. Awareness of cancer warning signs was low when open-ended (recall) questions were used and higher with closed (recognition) questions; but on either measure, awareness was lower in those who were male, younger, and from lower socio-economic status (SES) groups or ethnic minorities. The most commonly endorsed barriers to help seeking were difficulty making an appointment, worry about wasting the doctor's time and worry about what would be found. Emotional barriers were more prominent in lower SES groups and practical barriers (e.g. too busy) more prominent in higher SES groups. Anticipated delay was lower in ethnic minority and lower SES groups. In multivariate analysis, higher symptom awareness was associated with lower anticipated delay, and more barriers with greater anticipated delay. A combination of public education about symptoms and empowerment to seek medical advice, as well as support at primary care level, could enhance early presentation and improve cancer outcomes.
278 citations
TL;DR: Mortality from circulatory diseases and all causes is not significantly different between vegetarians and meat eaters, but the study is not large enough to exclude small or moderate differences for specific causes of death, and more research on this topic is required.
226 citations
TL;DR: These studies show the psychometric properties of the CAM and support its validity as a measure of cancer awareness in the general population.
Abstract: BACKGROUND: We aimed to develop and validate a measurement tool to assess cancer awareness in the general population: the cancer awareness measure (CAM).METHODS: Items assessing awareness of cancer warning signs, risk factors, incidence, screening programmes and attitudes towards help seeking were extracted from the literature or generated by expert groups. To determine reliability, the CAM was administered to a university participant panel (n = 148), with a sub-sample (n = 94) completing it again 2 weeks later. To establish construct validity, CAM scores of cancer experts (n = 12) were compared with those of non-medical academics (n = 21). Finally, university students (n = 49) were randomly assigned to read either a cancer information leaflet or a leaflet with control information before completing the measure, to ensure the CAM was sensitive to change.RESULTS: Cognitive interviewing indicated that the CAM was being interpreted as intended. Internal reliability (Cronbach's alpha = 0.77) and test-retest reliability (r = 0.81) were high. Scores for cancer experts were significantly higher than those for non-medical academics (t(31) 6.8, P < 0.001). CAM scores were higher among students who received an intervention leaflet than the control leaflet (t(47) 4.8, P < 0.001).CONCLUSIONS: These studies show the psychometric properties of the CAM and support its validity as a measure of cancer awareness in the general population. British Journal of Cancer (2009) 101, S13-S17. doi: 10.1038/sj.bjc.6605385 www.bjcancer.com (C) 2009 Cancer Research UK
190 citations
TL;DR: There is some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation, although the evidence is limited.
Abstract: BACKGROUND: Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research. METHODS: We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled studies of interventions delivered to communities. RESULTS: We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation. We found limited evidence that public education campaigns reduce stage at presentation of breast cancer, malignant melanoma and retinoblastoma. CONCLUSION: Interventions delivered to individuals may increase cancer awareness. Interventions delivered to communities may promote cancer awareness and early presentation, although the evidence is limited.
178 citations
TL;DR: It is indicated that, despite substantial efforts, the recommendations of the Council of the EU on organised population-based screening for cervical cancer are not yet fulfilled and decision-makers and health service providers should consider stronger measures or incentives in order to improve cervical cancer control in Europe.
174 citations
International Agency for Research on Cancer1, Norwich University2, Institut Gustave Roussy3, University of Cambridge4, Basque Government5, European Food Safety Authority6, National and Kapodistrian University of Athens7, Lund University8, Umeå University9, German Cancer Research Center10, Cancer Epidemiology Unit11, Utrecht University12, University of Tromsø13, Imperial College London14, MRC Mitochondrial Biology Unit15
TL;DR: The contribution of highly processed foods to total diet, nutrient intakes and patterns among 27 redefined centres in the 10 countries participating in the European Prospect... as mentioned in this paper, in terms of food consumption, nutrient intake and consumption patterns.
Abstract: Objectives: To describe the contribution of highly processed foods to total diet, nutrient intakes and patterns among 27 redefined centres in the 10 countries participating in the European Prospect ...
158 citations
TL;DR: Evidence is found that cryptorchidism, inguinal hernia and twinning, and tentative evidence that birth weight and gestational age, are associated with risk of testicular cancer.
Abstract: Background We undertook a systematic review and meta-analysis of perinatal variables in relation to testicular cancer risk, with a specific focus upon characteristics of the mother.
Methods EMBASE, PubMed, Scopus and Web of Science databases were searched using sensitive search strategies. Meta-analysis was undertaken using STATA 10.
Results A total of 5865 references were retrieved, of which 67 met the inclusion criteria and contributed data to at least one perinatal analysis. Random effects meta-analysis found maternal bleeding during pregnancy [odds ratio (OR) 1.33, 95% confidence interval (CI) 1.02–1.73], birth order (primiparous vs not, 1.08, 95% CI 1.01–1.16; second vs first, OR 0.94, 95% CI 0.88–0.99; third vs first, OR 0.91, 95% CI 0.83–1.01; fourth vs first, OR 0.80, 95% CI 0.69–0.94) and sibship size (2 vs 1, OR 0.93, 95% CI 0.75–1.15; 3 vs 1, OR 0.89, 95% CI 0.74–1.07; 4 vs 1, OR 0.75, 95% CI 0.62–0.90) to be associated with testicular cancer risk. Meta-analyses that produced summary estimates which indicated no association included maternal age, maternal nausea, maternal hypertension, pre-eclampsia, breech delivery and caesarean section. Meta-regression provided evidence that continent of study is important in the relationship between caesarean section and testicular cancer (P = 0.035), and a meta-analysis restricted to the three studies from the USA was suggestive of association (OR 1.67, 95% CI 1.07–2.56).
Conclusions This systematic review and meta-analysis has found evidence for associations of maternal bleeding, birth order, sibship size and possibly caesarean section with risk of testicular cancer.
153 citations
TL;DR: The overall cancer incidence rates of both the vegetarians and the nonvegetarians in this study are low compared with national rates.
TL;DR: The pattern of hypermethylation may have changed after the introduction of prostate-specific antigen testing in the beginning of the 1990s, and promoter methylation in APC was identified as a marker for prostate cancer progression.
Abstract: PURPOSE There is a need to better understand prostate cancer progression and identify new prognostic markers for this tumor We investigated the association between promoter methylation in a priori selected genes and survival in two independent large series of prostate cancer patients METHODS We followed up with two cohorts of patients (216 patients diagnosed in 1982 to 1988 and 243 patients diagnosed in 1993 to 1996) diagnosed at one hospital pathology ward in Turin, Italy DNA was obtained from paraffin-embedded tumor tissues and evaluated for promoter methylation status in glutathione S-transferase (GSTP1), adenomatous polyposis coli (APC), and runt-related transcription factor 3 (RUNX3) Results The two cohorts had different prevalences of methylation in APC (P = 047), GSTP1 (P = 002), and RUNX3 (P < 001) Methylation in APC was associated with an increased risk of prostate cancer-specific mortality (hazard ratio [HR] = 142; 95% CI, 098 to 207 in the 1980s cohort; HR = 157; 95% CI, 095 to 262 in the 1990s cohort; HR = 149; 95% CI, 111 to 200 in the two cohorts combined) In subgroup analyses, the HRs were higher among patients with a Gleason score less than 8 (HR = 152; 95% CI, 085 to 273 in the 1980s cohort; HR = 209; 95% CI, 102 to 428 in the 1990s cohort) Methylation in RUNX3 was associated with prostate cancer mortality only in the 1990s cohort, and methylation in GSTP1 did not predict mortality in either cohort CONCLUSION The pattern of hypermethylation may have changed after the introduction of prostate-specific antigen testing in the beginning of the 1990s Promoter methylation in APC was identified as a marker for prostate cancer progression
Imperial College London1, University Medical Center Utrecht2, Umeå University3, National and Kapodistrian University of Athens4, Cancer Epidemiology Unit5, Prevention Institute6, Andalusian School of Public Health7, University of Cambridge8, Malmö University9, Sahlgrenska University Hospital10, Aarhus University Hospital11, French Institute of Health and Medical Research12, University of Tromsø13
TL;DR: The extensive longitudinal data of the European Prospective Investigation into Cancer and Nutrition (EPIC) were used to evaluate age‐specific mortality rates from ALS and the role of cigarette smoking on the risk of dying from ALS.
Abstract: OBJECTIVE: Cigarette smoking has been reported as "probable" risk factor for Amyotrophic Lateral Sclerosis (ALS), a poorly understood disease in terms of aetiology. The extensive longitudinal data of the European Prospective Investigation into Cancer and Nutrition (EPIC) were used to evaluate age-specific mortality rates from ALS and the role of cigarette smoking on the risk of dying from ALS. METHODS: A total of 517,890 healthy subjects were included, resulting in 4,591,325 person-years. ALS cases were ascertained through death certificates. Cox hazard models were built to investigate the role of smoking on the risk of ALS, using packs/years and smoking duration to study dose-response. RESULTS: A total of 118 subjects died from ALS, resulting in a crude mortality rate of 2.69 per 100,000/year. Current smokers at recruitment had an almost two-fold increased risk of dying from ALS compared to never smokers (HR = 1.89, 95% C.I. 1.14-3.14), while former smokers at the time of enrollment had a 50% increased risk (HR = 1.48, 95% C.I. 0.94-2.32). The number of years spent smoking increased the risk of ALS (p for trend = 0.002). Those who smoked more than 33 years had more than a two-fold increased risk of ALS compared with never smokers (HR = 2.16, 95% C.I. 1.33-3.53). Conversely, the number of years since quitting smoking was associated with a decreased risk of ALS compared with continuing smoking. INTERPRETATION: These results strongly support the hypothesis of a role of cigarette smoking in aetiology of ALS. We hypothesize that this could occur through lipid peroxidation via formaldehyde exposure.
TL;DR: The study suggests the need for culturally sensitive, community-based interventions to raise awareness and encourage early presentation in cancer diagnosis in Britain.
Abstract: Little is known about ethnic differences in awareness of cancer-warning signs or help-seeking behaviour in Britain. As part of the National Awareness and Early Diagnosis Initiative (NAEDI), this study aimed to explore these factors as possible contributors to delay in cancer diagnosis. We used quota sampling to recruit 1500 men and women from the six largest minority ethnic groups in England (Indian, Pakistani, Bangladeshi, Caribbean, African and Chinese). In face-to-face interviews, participants completed the newly developed cancer awareness measure (CAM), which includes questions about warning signs for cancer, speed of consultation for possible cancer symptoms and barriers to help seeking. Awareness of warning signs was low across all ethnic groups, especially using the open-ended (recall) question format, with lowest awareness in the African group. Women identified more emotional barriers and men more practical barriers to help seeking, with considerable ethnic variation. Anticipated delay in help seeking was higher in individuals who identified fewer warning signs and more barriers. The study suggests the need for culturally sensitive, community-based interventions to raise awareness and encourage early presentation.
University of Cambridge1, University of East Anglia2, International Agency for Research on Cancer3, Institut Gustave Roussy4, Lund University5, Umeå University6, European Food Safety Authority7, University of Tromsø8, Cancer Epidemiology Unit9, Basque Government10, Utrecht University11, Aarhus University Hospital12, National and Kapodistrian University of Athens13, German Cancer Research Center14, University of Kiel15, Imperial College London16, MRC Mitochondrial Biology Unit17
TL;DR: Intakes of minerals vary substantially throughout Europe, with some geographical variability in their food sources, including around a twofold north–south gradient in the contribution of fruits and vegetables to potassium intake.
Abstract: Background/objectives: Adequate mineral intake is important for the maintenance of bone health, cellular function and general metabolism, and possibly in the aetiology of cancer and other chronic diseases. This study aimed at investigating variation in intakes of selected minerals across 10 European countries participating in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. Methods: Nutrient intakes for 36 034 subjects, aged between 35 and 74 years, in 27 centres were obtained using standardized 24-h dietary recall software (EPIC-SOFT). Mean intakes of calcium, phosphorus, magnesium, iron and potassium were calculated by centre and weighted by season and day of the week and were also stratified by age group. The contribution of food groups to total nutrient intake was calculated. Results: There was clear geographical variability in intakes, with differences ranging from 35% for magnesium to 90% for iron in men and 36% for potassium to 75% for calcium in women, and a twofold difference in sources of haem iron (meat and fish). There was a geographical gradient in iron intake, with higher intakes in Southern than in Northern Europe and also around a twofold north-south gradient in the contribution of fruits and vegetables to potassium intake. Compared with reference intakes, the majority of age groups and centres had intakes above the recommended levels. Dairy foods and products contributed the most to calcium and phosphorus intake in almost all centres. Cereals and cereal products contributed the most to magnesium and iron intakes, except in Greece and Germany. Conclusions: Intakes of minerals vary substantially throughout Europe, with some geographical variability in their food sources. European Journal of Clinical Nutrition (2009) 63, S101-S121; doi: 10.1038/ejcn.2009.77
TL;DR: Evidence is provided in support of a protective effect of circulating concentrations of vitamin D on the risk of prostate cancer in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (1994–2000).
Abstract: Results from the majority of studies show little association between circulating concentrations of vitamin D and prostate cancer risk, a finding that has not been demonstrated in a wider European population, however. The authors examined whether vitamin D concentrations were associated with prostate cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (1994-2000). Serum concentrations of 25-hydroxyvitamin D were measured in 652 prostate cancer cases matched to 752 controls from 7 European countries after a median follow-up time of 4.1 years. Conditional logistic regression models were used to calculate odds ratios for prostate cancer risk in relation to serum 25-hydroxyvitamin D after standardizing for month of blood collection and adjusting for covariates. No significant association was found between 25-hydroxyvitamin D and risk of prostate cancer (highest vs. lowest quintile: odds ratio = 1.28, 95% confidence interval: 0.88, 1.88; P for trend = 0.188). Subgroup analyses showed no significant heterogeneity by cancer stage or grade, age at diagnosis, body mass index, time from blood collection to diagnosis, or calcium intake. In summary, the results of this large nested case-control study provide no evidence in support of a protective effect of circulating concentrations of vitamin D on the risk of prostate cancer.
National and Kapodistrian University of Athens1, International Agency for Research on Cancer2, Lund University3, German Cancer Research Center4, Utrecht University5, Malmö University6, Umeå University7, University of Tromsø8, University of Cambridge9, Cancer Epidemiology Unit10, Institut Gustave Roussy11, Imperial College London12, MRC Mitochondrial Biology Unit13
TL;DR: In northern Europe, OH and in-home eating are homogeneous, whereas southern Europeans consider OH eating as a distinctive occasion, and in most centres, women selected more fat-rich items when eating out.
Abstract: To assess the contribution of out-of-home (OH) energy and nutrient intake to total dietary intake, and to compare out- versus in-home nutrient patterns among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Between 1995 and 2000, 36 034 participants aged between 35–74 years completed a standardized 24-h dietary recall using a software programme (EPIC-Soft) that recorded the place of food/drink consumption. Eating OH was defined as the consumption of foods and beverages anywhere other than in household premises, irrespective of the place of purchase/preparation. Nutrient intakes were estimated using a standardized nutrient database. Mean intakes were adjusted for age and weighted by season and day of recall. Among women, OH eating contributed more to total fat intake than to intakes of protein and carbohydrates. Among both genders, and particularly in southern Europe, OH eating contributed more to sugar and starch intakes and less to total fibre intake. The contribution of OH eating was also lower for calcium and vitamin C intakes. The composition of diet at home was different from that consumed out of home in southern countries, but was relatively similar in the north. In northern Europe, OH and in-home eating are homogeneous, whereas southern Europeans consider OH eating as a distinctive occasion. In most centres, women selected more fat-rich items when eating out.
TL;DR: The incidence of some cancers may be lower in fish eaters and vegetarians than in meat eaters.
Abstract: Background:
Few prospective studies have examined cancer incidence among vegetarians.
Methods:
We studied 61 566 British men and women, comprising 32 403 meat eaters, 8562 non-meat eaters who did eat fish ('fish eaters') and 20 601 vegetarians. After an average follow-up of 12.2 years, there were 3350 incident cancers of which 2204 were among meat eaters, 317 among fish eaters and 829 among vegetarians. Relative risks (RRs) were estimated by Cox regression, stratified by sex and recruitment protocol and adjusted for age, smoking, alcohol, body mass index, physical activity level and, for women only, parity and oral contraceptive use.
Results:
There was significant heterogeneity in cancer risk between groups for the following four cancer sites: stomach cancer, RRs (compared with meat eaters) of 0.29 (95% CI: 0.07–1.20) in fish eaters and 0.36 (0.16–0.78) in vegetarians, P for heterogeneity=0.007; ovarian cancer, RRs of 0.37 (0.18–0.77) in fish eaters and 0.69 (0.45–1.07) in vegetarians, P for heterogeneity=0.007; bladder cancer, RRs of 0.81 (0.36–1.81) in fish eaters and 0.47 (0.25–0.89) in vegetarians, P for heterogeneity=0.05; and cancers of the lymphatic and haematopoietic tissues, RRs of 0.85 (0.56–1.29) in fish eaters and 0.55 (0.39–0.78) in vegetarians, P for heterogeneity=0.002. The RRs for all malignant neoplasms were 0.82 (0.73–0.93) in fish eaters and 0.88 (0.81–0.96) in vegetarians (P for heterogeneity=0.001).
Conclusion:
The incidence of some cancers may be lower in fish eaters and vegetarians than in meat eaters.
TL;DR: It is concluded that epidemiologic studies provide little support for existence of a widespread TDS because there are no consistent non-causal associations between its different manifestations and furthermore little evidence of shared causes between the alleged components of the syndrome.
Abstract: The concept of an increasingly common Testicular Dysgenesis Syndrome (TDS) has been widely adopted with little epidemiological appraisal. In this paper we critically review the epidemiologic evidence of the existence of a non-genetic TDS. We systematically assess and discuss the evidence of all six possible associations between the four defining conditions of TDS: impaired spermatogenesis, undescended testis, hypospadia and testicular cancer. We also evaluate whether there are common risk factors for these four conditions. We conclude that epidemiologic studies provide little support for existence of a widespread TDS because there are no consistent non-causal associations between its different manifestations. There is furthermore little evidence of shared causes between the alleged components of the syndrome.
TL;DR: There is strong evidence of a difference in overall survival in screening attendees and nonattendees of a 1-time screening for prostate cancer and this findings should be considered when interpreting previous and upcoming studies of the effect of screening programs.
TL;DR: Waist–hip ratio (WHR), a measure of central adiposity, was positively associated with PCa before age 65, and less strongly, with total PCa, independent of body mass index (BMI) and other potential confounders.
Abstract: Obesity may be associated with increased risk of prostate cancer (PCa). According to one hypothesis, obesity could lower the risk of non-aggressive tumours, while simultaneously increasing the risk of aggressive cancer. Furthermore, central adiposity may be independently associated with PCa risk; it is also associated with diabetes, which itself may influence risk of PCa. We studied the associations between height, body composition, and fat distribution, diabetes prevalence and risk of total, aggressive, and non-aggressive PCa in 10 564 initially cancer-free men (aged 45–73 years) of the population-based Malmo Diet and Cancer cohort. Anthropometric and body composition measurements, including bioelectrical impedance for estimation of fat mass, were performed by study nurses. Diabetes prevalence was self-reported. Cancer cases and clinical characteristics were ascertained through national and regional registry data. Dietary and other background data were obtained through a modified diet history method and an extensive questionnaire. During a mean follow-up of 11.0 years, 817 incidental PCa cases were diagnosed. Of these, 281 were classified as aggressive. There were 202 cases occurring before 65 years of age. Height was positively associated with total and non-aggressive PCa risk. Waist–hip ratio (WHR), a measure of central adiposity, was positively associated with PCa before age 65, and less strongly, with total PCa. This association was independent of body mass index (BMI) and other potential confounders. General adiposity, expressed as BMI or body fat percentage, and prevalent diabetes were not associated with PCa risk. In this study, WHR and body height were stronger PCa predictors than general adiposity.
TL;DR: In 1‐sided undescended testis, the risk of testicular cancer may be increased in both testes, although to a much greater extent on the ipsilateral side.
Abstract: The association between undescended testis (cryptorchidism) and testicular cancer is established, but it is not known whether the risk of testicular cancer among men with unilateral maldescent is increased in both testes, or only on the undescended side. This is a meta-analysis of 11 case-control studies and 1 cohort study that all assessed the risk of testicular cancer separately for the undescended and descended testis. We used fixed-effects meta-analysis to calculate pooled estimates and 95% confidence intervals (CIs) for the relative risk. Of 199 tumors in men with unilateral cryptorchidism, 158 (79%) were on the ipsilateral side and 41 (21%) on the contralateral side. The pooled relative risks for testicular cancer in the ipsilateral and contralateral testis were 6.33 (95% CI, 4.30 to 9.31) and 1.74 (95% CI, 1.01 to 2.98), respectively. We conclude that in 1-sided undescended testis, the risk of testicular cancer may be increased in both testes, although to a much greater extent on the ipsilateral side.
TL;DR: A combination of public education about symptoms and empowerment to seek medical advice, as well as support at primary care level, could enhance early presentation and improve cancer outcomes.
Abstract: *_Objective:_* To assess public awareness of cancer warning signs, anticipated delay, and perceived barriers to seeking medical advice in the British population. Methods: We carried out a population-based survey using face-to-face, computer-assisted interviews to administer the Cancer Awareness Measure (CAM), a newly-developed, validated measure of cancer awareness. The sample included 2216 adults (970 male and 1246 female) recruited as part of the Office for National Statistics Opinions Survey using stratified probability sampling.*_Results:_* Awareness of cancer warning signs was low when open-ended (recall) questions were used and higher with closed (recognition) questions; but on either measure, awareness was lower in those who were male, younger, and from lower socioeconomic status (SES) groups or ethnic minorities. The most commonly endorsed barriers to help-seeking were difficulty making an appointment, worry about wasting the doctor’s time and worry about what would be found. Emotional barriers were more prominent in lower SES groups and practical barriers (e.g. too busy) more prominent in higher SES groups. Anticipated delay was lower in ethnic minority and lower SES groups. In multivariate analysis, higher symptom awareness was associated with lower anticipated delay, and more barriers with greater anticipated delay.*_Conclusions:_* A combination of public education about symptoms and empowerment to seek medical advice, as well as support at primary care level, could enhance early presentation and improve cancer outcomes.
TL;DR: It is concluded that levels of mercury in Spain are among the highest in the non-exposed populations probably because of the relatively high fish consumption.
Abstract: Exposure to mercury, a risk factor for neurodevelopmental toxicity, was assessed in Spanish children (preschool children and newborns, n = 218) in a four-locations survey by performing mercury determination in hair. To assess the prenatal and children's exposure and its potential risk, total mercury (THg) and methylmercury (MeHg) were analyzed and examined for associations with maternal sociodemographic characteristics and dietary intake through interviews and food frequency questionnaires. The mean THg in hair was 0.94 microg/g, ranging from 0.19 to 5.63 microg/g in preschool children and 1.68 microg/g (0.13-8.43 microg/g) in newborns. Associations between mercury levels in hair and fish consumption frequency were found regardless of the group evaluated. Neither other food item nor maternal covariates were associated with mercury levels in the newborn group. In children, the mean THg values among frequent fish consumers (more than four times per week) were almost threefold higher compared with non-consumers (1.40 vs. 0.49 microg/g). Newborns from mothers who had intake of fish two or more times per week exhibited nearly threefold higher hair levels than those who rarely or never consumed fish (2.26 vs. 0.78 microg/g). Finally, mercury levels in hair exceeded the EPA reference dose (RfD) of 0.1 microg Hg/kg body weight per day (equivalent to 1 microg Hg/g hair) in 42% of the population studied. Overall, we conclude that levels of mercury in Spain are among the highest in the non-exposed populations probably because of the relatively high fish consumption.
TL;DR: The effect of both age at menarche and age at first birth was greatest for lobular tumours, and increasing parity reduced the risk of each tumour type, except medullary cancers, but the reduction in risk was greater for mucinous cancers than for any other subtype considered.
Abstract: Little is known about how reproductive factors affect the risk of breast cancers of different histology. In an analysis of prospective data on 1.2 million middle-aged UK women, we used proportional hazards models to estimate the relative risks of six histological types in relation to menarche, childbearing and menopause. During 8.7 million person-years of follow-up, 17 923 ductal, 3332 lobular, 1062 tubular, 944 mixed ductal lobular, 330 mucinous and 117 medullary cancers were diagnosed. The effect of both age at menarche and age at first birth was greatest for lobular tumours; relative risks per 5-year increase in age at menarche for ductal, lobular, and tubular cancers were 0.93 (0.87–0.99), 0.65 (0.56–0.76), and 0.75 (0.57–0.98), respectively (P-value for heterogeneity=0.0001); and the relative risks per 5-year increase in age at first birth were 1.10 (1.07–1.12), 1.23 (1.17–1.29), and 1.13 (1.03–1.23), respectively (P-value for heterogeneity=0.0006). Increasing parity reduced the risk of each tumour type, except medullary cancers, but the reduction in risk was greater for mucinous cancers than for any other subtype considered (P<0.05 for comparison with each other subtype in turn). The effect of menopause did not vary significantly by tumour histology. Meta-analysis of published results on the effects of age at menarche and age at first birth on ductal and lobular cancers were in keeping with our findings.
TL;DR: Internal validations showed that the observed association between traffic density in the zone of residence and respiratory symptoms did not appear to be explained by an over reporting of traffic by parents of symptomatic subjects, and the results of validation of studies on self-reported traffic exposure can not be generalized.
Abstract: Epidemiological studies have provided evidence that exposure to vehicular traffic increases the prevalence of respiratory symptoms and may exacerbate pre-existing asthma in children. Self-reported exposure to road traffic has been questioned as a reliable measurement of exposure to air pollutants. The aim of this study was to investigate whether there were specific effects of cars and trucks traffic on current asthma symptoms (i.e. wheezing) and cough or phlegm, and to examine the validity of self-reported traffic exposure. The survey was conducted in 2002 in 12 centers in Northern, Center and Southern Italy, different in size, climate, latitude and level of urbanization. Standardized questionnaires filled in by parents were used to collect information on health outcomes and exposure to traffic among 33,632 6–7 and 13–14 years old children and adolescents. Three questions on traffic exposure were asked: the traffic in the zone of residence, the frequency of truck and of car traffic in the street of residence. The presence of a possible response bias for the self-reported traffic was evaluated using external validation (comparison with measurements of traffic flow in the city of Turin) and internal validations (matching by census block, in the cities of Turin, Milan and Rome). Overall traffic density was weakly associated with asthma symptoms but there was a stronger association with cough or phlegm (high traffic density OR = 1.24; 95% CI: 1.04, 1.49). Car and truck traffic were independently associated with cough or phlegm. The results of the external validation did not support the existence of a reporting bias for the observed associations, for all the self-reported traffic indicators examined. The internal validations showed that the observed association between traffic density in the zone of residence and respiratory symptoms did not appear to be explained by an over reporting of traffic by parents of symptomatic subjects. Children living in zones with intense traffic are at higher risk for respiratory effects. Since population characteristics are specific, the results of validation of studies on self-reported traffic exposure can not be generalized.
TL;DR: Smoking, height, body mass index, alcohol consumption and physical activity showed little or no association with pancreatic cancer risk, and these factors were also associated with increased mortality from Pancreatic cancer.
Abstract: Risk factors for pancreatic cancer, other than smoking and diabetes, are not well-established, especially for women. In a cohort of 1.3 million middle-aged women, followed for 9.2 million personyears for cancer incidence and 11.5 million person-years for mortality, there were 1,338 incident pancreatic cancer cases and 1,710 deaths from the disease. Using proportional hazards models, we calculated adjusted relative risks (RRs) and 95% confidence intervals (CIs) by smoking, height, body mass index (BMI), alcohol consumption, physical activity and history of diabetes. Pancreatic cancer incidence was greater in current than never smokers (RR 2.39, CI 2.10-2.73), the risk increasing with the number of cigarettes smoked. The incidence of pancreatic cancer also increased with increasing BMI (RR 1.34, CI 1.13-1.57 for BMI ≥ 30 vs. 22.5-25 kg/m 2), and with a history of diabetes (RR 1.58, CI 1.22-2.03, with vs. without such a history). These factors were also associated with increased mortality from pancreatic cancer. Height, alcohol consumption and physical activity showed little or no association with pancreatic cancer risk. © 2008 Wiley-Liss, Inc.
TL;DR: A lower referral of 15- to 19-year-old adolescents to paediatric oncology units and their under-representation in clinical trials is confirmed and a progressive improvement in this situation in recent years is observed.
TL;DR: The number of rare malignant pediatric tumors expected to be diagnosed in Italy with the number of cases actually enrolled in the TREP database in 2000–2006 is compared.
Abstract: Rare malignant pediatric tumors are essentially orphan diseasesand make up a variety of neoplasms with particular biological andclinicalcharacteristics.Someofthesetumorsarerareatanyage,butmost are particularly rare in childhood and adolescence [1].In 2000, a nationwide Italian cooperative project, called theTREP (Tumori Rari in Eta` Pediatrica or Rare Tumours in PediatricAge) project, was launched in Italy under the auspices of theAssociazione Italiana Ematologia Oncologia Pediatrica (AIEOP),and in cooperation with the Societa` Italiana Chirurgia Pediatrica(SICP) to improve basic research on these tumors and their clinicalmanagement. The project aimed to establish a network of pediatricand adult oncologists, surgeons, pathologists and biologists, to poolclinical data, and develop diagnostic and therapeutic recommenda-tions for each of these rare tumors [2].As a first step, the TREP group gave an arbitrary but pragmaticdefinition of ‘‘rare pediatric tumors,’’ defining them as solidmalignancies characterized by annual incidence rates of less than2 per million children (0–14 years) and not enrolled in specificclinical trials. The list included: nasopharyngeal carcinoma,adrenocortical tumors, pleuro-pulmonary blastoma (and other lungtumors), carcinoid tumors, cutaneous melanoma, renal carcinoma,pancreatoblastoma (and other pancreatic exocrine tumors), gonadalnon-germ-cell tumors (ovary/testis), pheochromocytoma and para-ganglioma, thyroid carcinoma, salivary gland tumors, breastcarcinoma, carcinoma of the gastrointestinal tract, and carcinomaof the thymus [2]. Therefore, the list excluded entities as renalrhabdoid tumors, that are registered in the national Wilms study;hepatoblastomaandmalignantgermcelltumors,thathavetheirownprotocols; rare histotypes of soft part sarcomas, that are covered bythe cooperative study on soft tissue sarcomas, as well as rare bonetumors; and other tumors whose incidence parallels that of rarepediatric tumors butwere already included in clinical trials. Centralnervous system tumors and hematological malignancies wereexcluded from the TREP list.TheTREPgrouphasalreadypublishedareportonitsfirst6yearsof activity. Here, we compare the number of these rare pediatrictumors expected to be diagnosed in Italy (based on incidence datafrom Italian network of well-established population-based cancerregistries [AIRTum]) [3] and the number of patients enrolled in theTREP project between 2000 and 2006, with a view to appraisingthe nationwide diffusion and efficacy of the TREP project. Thestudy analyzed the differences in the patterns of referral of children(0–14 years old) and adolescents less than 18 years (15–17 yearsold) with rare malignant tumors.
TL;DR: Hormonal and reproductive factors affect the risk of hip and knee replacement, more so for the knee than the hip.
Abstract: Objectives: To examine the effect of reproductive history and use of hormonal therapies on the risk of hip and knee joint replacement for osteoarthritis. Methods: Prospective study of 1.3 million women aged on average 56 years at recruitment and followed-up through linkage to routinely collected hospital admission records. The adjusted relative risk of hip and knee replacement for osteoarthritis was examined in relation to parity, age at menarche, menopausal status, age at menopause, and use of hormonal therapies. Results: Over a mean of 6.1 person-years of follow-up 12,124 women had a hip replacement and 9,977 a knee replacement. The risk of joint replacement increased with increasing parity and the effect was greater for the knee than the hip: increase in relative risk of 2% (95%CI 1-4%) per birth for hip replacement and 8% (95%CI 6-10%) for knee replacement. An early age at menarche slightly increased the risk of both hip and knee replacement (relative risk for menarche iU11yrs versus 12yrs 1.09(95%CI 1.03-1.16) and 1.15(95%CI 1.08-1.22) respectively). Menopausal status and age at menopause were not clearly associated with risk. Current use of post-menopausal hormone therapy was associated with a significant increase in the incidence of both hip and knee replacement (RR=1.38(95%CI 1.30-1.46) and RR=1.58(95%CI 1.48-1.69) respectively) while previous use of oral contraceptives was not (RR=1.02(95%CI 0.98-1.06) and RR=1.00(95%CI 0.96-1.04) for hip and knee respectively). Conclusions: Hormonal and reproductive factors affect the risk of hip and knee replacement, more so for the knee than the hip. The reasons for this are unclear.