Showing papers by "Cancer Epidemiology Unit published in 2011"
TL;DR: Findings on shift work, in relation to risks of CVD, metabolic syndrome and diabetes are also suggestive but not conclusive for an adverse relationship, making it difficult to draw general conclusions.
Abstract: Background Shift work, including night work, has been hypothesized to increase the risk of chronic diseases, including cancer, cardiovascular disease (CVD), metabolic syndrome and diabetes. Recent reviews of evidence relating to these hypotheses have focussed on specific diseases or potential mechanisms, but no general summary of the current data on shift work and chronic disease has been published.
Methods Systematic and critical reviews and recent original studies indexed in PubMed prior to 31 December 2009 were retrieved, aided by manual searches of reference lists. The main conclusions from reviews and principle results from recent studies are presented in text and tables.
Results Published evidence is suggestive but not conclusive for an adverse association between night work and breast cancer but limited and inconsistent for cancers at other sites and all cancers combined. Findings on shift work, in relation to risks of CVD, metabolic syndrome and diabetes are also suggestive but not conclusive for an adverse relationship.
Conclusions Heterogeneity of study exposures and outcomes and emphasis on positive but non-significant results make it difficult to draw general conclusions. Further data are needed for additional disease endpoints and study populations.
514 citations
TL;DR: Advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.
Abstract: The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established. For cancers of the upper gastrointestinal tract, epidemiological studies have generally observed that people with a relatively high intake of fruit and vegetables have a moderately reduced risk, but these observations must be interpreted cautiously because of potential confounding by smoking and alcohol. For lung cancer, recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and reduced risk. For other common cancers, including colorectal, breast and prostate cancer, epidemiological studies suggest little or no association between total fruit and vegetable consumption and risk. It is still possible that there are benefits to be identified: there could be benefits in populations with low average intakes of fruit and vegetables, such that those eating moderate amounts have a lower cancer risk than those eating very low amounts, and there could also be effects of particular nutrients in certain fruits and vegetables, as fruit and vegetables have very varied composition. Nutritional principles indicate that healthy diets should include at least moderate amounts of fruit and vegetables, but the available data suggest that general increases in fruit and vegetable intake would not have much effect on cancer rates, at least in well-nourished populations. Current advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.
298 citations
TL;DR: In this paper, the authors used Cox regression models to calculate adjusted relative risks (RRs) per 10 cm increase in measured height for total incident cancer and for 17 specific cancer sites, taking attained age as the underlying time variable.
Abstract: Summary Background Epidemiological studies have shown that taller people are at increased risk of cancer, but it is unclear if height-associated risks vary by cancer site, or by other factors such as smoking and socioeconomic status. Our aim was to investigate these associations in a large UK prospective cohort with sufficient information on incident cancer to allow direct comparison of height-associated risk across cancer sites and in relation to major potential confounding and modifying factors. Methods Information on height and other factors relevant for cancer was obtained in 1996–2001 for middle-aged women without previous cancer who were followed up for cancer incidence. We used Cox regression models to calculate adjusted relative risks (RRs) per 10 cm increase in measured height for total incident cancer and for 17 specific cancer sites, taking attained age as the underlying time variable. We also did a meta-analysis of published results from prospective studies of total cancer risk in relation to height. Findings 1 297 124 women included in our analysis were followed up for a total of 11·7 million person-years (median 9·4 years per woman, IQR 8·4–10·2), during which time 97 376 incident cancers occurred. The RR for total cancer was of 1·16 (95% CI 1·14–1·17; p Interpretation Cancer incidence increases with increasing adult height for most cancer sites. The relation between height and total cancer RR is similar in different populations. Funding Cancer Research UK and the UK Medical Research Council.
266 citations
TL;DR: Consuming a vegetarian diet and a high intake of dietary fibre were both associated with a lower risk of admission to hospital or death from diverticular disease.
Abstract: Objective To examine the associations of a vegetarian diet and dietary fibre intake with risk of diverticular disease. Design Prospective cohort study. Setting The EPIC-Oxford study, a cohort of mainly health conscious participants recruited from around the United Kingdom. Participants 47 033 men and women living in England or Scotland of whom 15 459 (33%) reported consuming a vegetarian diet. Main outcome measures Diet group was assessed at baseline; intake of dietary fibre was estimated from a 130 item validated food frequency questionnaire. Cases of diverticular disease were identified through linkage with hospital records and death certificates. Hazard ratios and 95% confidence intervals for the risk of diverticular disease by diet group and fifths of intake of dietary fibre were estimated with multivariate Cox proportional hazards regression models. Results After a mean follow-up time of 11.6 years, there were 812 cases of diverticular disease (806 admissions to hospital and six deaths). After adjustment for confounding variables, vegetarians had a 31% lower risk (relative risk 0.69, 95% confidence interval 0.55 to 0.86) of diverticular disease compared with meat eaters. The cumulative probability of admission to hospital or death from diverticular disease between the ages of 50 and 70 for meat eaters was 4.4% compared with 3.0% for vegetarians. There was also an inverse association with dietary fibre intake; participants in the highest fifth (≥25.5 g/day for women and ≥26.1 g/day for men) had a 41% lower risk (0.59, 0.46 to 0.78; P Conclusions Consuming a vegetarian diet and a high intake of dietary fibre were both associated with a lower risk of admission to hospital or death from diverticular disease.
266 citations
TL;DR: There was substantial heterogeneity in breast cancer risk among current users of hormonal therapy, which was greater among users of estrogen–progestin than estrogen-only formulations and if hormonal therapy started at around the time of menopause than later.
Abstract: Results During 4.05 million woman-years of follow-up, 15 759 incident breast cancers occurred, with 7107 in current users of hormonal therapy. Breast cancer incidence was increased in current users of hormonal therapy, returning to that of never users a few years after use had ceased. The relative risks for breast cancer in current users were greater if hormonal therapy was begun before or soon after menopause than after a longer gap ( P heterogeneity < .001, for both estrogen-only and estrogen-progestin formulations). Among current users of estrogen-only formulations , there was little or no increase in risk if use began 5 years or more after menopause ( RR = 1.05, 95% confidence interval [CI] = 0.89 to 1.24), but risk was statistically significantly increased if use began before or less than 5 years after menopause (RR = 1.43, 95% CI = 1.35 to 1.51). A similar pattern was observed among current users of estrogen – progestin formulations (RR = 1.53, 95% CI = 1.38 to 1.70, and RR = 2.04, 95% CI = 1.95 to 2.14, respectively). At 50 – 59 years of age , annual standardized incidence rates for breast cancer were 0.30 % (95% CI = 0.29% to 0.31%) among never users of hormone therapy and 0.43% (95% CI = 0.42% to 0.45%) and 0.61% (95% CI = 0.59% to 0.64%), respectively, among current users of estrogen-only and estrogen – progestin formulations who began use less than 5 years after menopause. Conclusions There was substantial heterogeneity in breast cancer risk among current users of hormonal therapy. Risks were greater among users of estrogen – progestin than estrogen-only formulations and if hormonal therapy started at around the time of menopause than later.
253 citations
TL;DR: The Oxford WebQ is self-administered and nutrients are estimated automatically, providing a low-cost method for measuring dietary intake in large-scale studies and compared with an interviewer-based 24 h dietary recall.
Abstract: Objectives: To describe the development of the Oxford WebQ, a web-based 24h dietary assessment tool developed for repeated administration in large prospective studies; and to report the preliminary assessment of its performance for estimating nutrient intakes. Design: We developed the Oxford WebQ by repeated testing until it was sufficiently comprehensive and easy to use. For the latest version, we compared nutrient intakes from volunteers who completed both the Oxford WebQ and an interviewer-administered 24h dietary recall on the same day. Setting: Oxford, UK. Subjects: A total of 116 men and women. Results: The WebQ took a median of 12? 5( interquartile range: 10?8‐16?3) min to self-complete and nutrient intakes were estimated automatically. By contrast, the interviewer-administered 24h dietary recall took 30min to complete and 30min to code. Compared with the 24h dietary recall, the mean Spearman’s correlation for the 21 nutrients obtained from the WebQ was 0?6, with the majority between 0? 5a nd 0?9. The mean differences in intake were less than 610% for all nutrients except for carotene and vitamins B12 and D. On rare occasions a food item was reported in only one assessment method, but this was not more frequent or systematically different between the methods. Conclusions: Compared with an interviewer-based 24h dietary recall, the WebQ captures similar food items and estimates similar nutrient intakes for a single day’s dietary intake. The WebQ is self-administered and nutrients are estimated automatically, providing a low-cost method for measuring dietary intake in large-scale studies.
225 citations
TL;DR: Investigation of differences in vitamin D intake and plasma concentrations among meat eater, fish eaters, vegetarians and vegans found diet is an important determinant of plasma 25(OH)D in this British population.
Abstract: Objective: Vegetarians and vegans exclude certain food sources of vitamin D from their diet, but it is not clear to what extent this affects plasma concentrations of 25-hydroxyvitamin D (25(OH)D). The objective was to investigate differences in vitamin D intake and plasma concentrations of 25(OH)D among meat eaters, fish eaters, vegetarians and vegans. Design: A cross-sectional analysis. Setting: United Kingdom. Subjects: Plasma 25(OH)D concentrations were measured in 2107 white men and women (1388 meat eaters, 210 fish eaters, 420 vegetarians and eighty-nine vegans) aged 20‐76 years from the European Prospective Investigation into Cancer and Nutrition (EPIC)‐Oxford cohort. Results: Plasma 25(OH)D concentrations reflected the degree of animal product exclusion and, hence, dietary intake of vitamin D; meat eaters had the highest mean intake of vitamin D (3?1 (95% CI 3?0, 3?2) mg/d) and mean plasma 25(OH)D concentrations (77?0 (95% CI 75?4, 78?8)nmol/l) and vegans the lowest (0?7 (95% CI 0?6, 0?8) mg/d and 55?8 (95% CI 51?0, 61?0)nmol/l, respectively). The magnitude of difference in 25(OH)D concentrations between meat eaters and vegans was smaller (20%) among those participants who had a blood sample collected during the summer months (July‐September) compared with the winter months (38%; January‐March). The prevalence of low plasma concentrations of 25(OH)D (,25nmol/l) during the winter and spring ranged from ,1% to 8% across the diet groups. Conclusions: Plasma 25(OH)D concentrations were lower in vegetarians and vegans than in meat and fish eaters; diet is an important determinant of plasma 25(OH)D in this British population.
216 citations
Cancer Epidemiology Unit1, German Cancer Research Center2, University of Tromsø3, South University4, Institut Gustave Roussy5, Aarhus University6, International Agency for Research on Cancer7, National and Kapodistrian University of Athens8, Prevention Institute9, University Medical Center Utrecht10, Utrecht University11, Andalusian School of Public Health12, Basque Government13, Lund University14, Umeå University15, University of Cambridge16, Imperial College London17
TL;DR: This study shows a strong protective association of oral contraceptives and parity with ovarian cancer risk, a higher risk with a late age at menopause, and no association with other reproductive factors.
Abstract: BACKGROUND: It is well established that parity and use of oral contraceptives reduce the risk of ovarian cancer, but the associations with other reproductive variables are less clear.METHODS: We ex ...
162 citations
TL;DR: This study supports a direct association between MetS and postmenopausal breast cancer risk, and the risk was higher at older age than previously thought.
137 citations
TL;DR: Estrogen‐only and combined MHT uses and continuous combined preparations were associated with increased breast cancer risk, and Continuous combined preparations was associated with the highest risk.
Abstract: Menopausal hormone therapy (MHT) is characterized by use of different constituents, regimens and routes of administration. We investigated the association between the use of different types of MHT and breast cancer risk in the EPIC cohort study. The analysis is based on data from 133,744 postmenopausal women. Approximately 133,744 postmenopausal women contributed to this analysis. Information on MHT was derived from country-specific self-administered questionnaires with a single baseline assessment. Incident breast cancers were identified through population cancer registries or by active follow-up (mean: 8.6 yr). Overall relative risks (RR) and 95% confidence interval (CI) were derived from country-specific Cox proportional hazard models estimates. A total of 4312 primary breast cancers were diagnosed during 1,153,747 person-years of follow-up. Compared with MHT never users, breast cancer risk was higher among current users of estrogen only (RR: 1.42, 95% CI 1.23-1.64) and higher still among current users of combined MHT (RR: 1.77, 95% CI 1.40-2.24; p = 0.02 for combined vs. estrogen-only). Continuous combined regimens conferred a 43% (95% CI: 19-72%) greater risk compared with sequential regimens. There was no significant difference between progesterone and testosterone derivatives in sequential regimens. There was no significant variation in risk linked to the estrogenic component of MHT, neither for oral vs. cutaneous administration nor for estradiol compounds vs. conjugated equine estrogens. Estrogen-only and combined MHT uses were associated with increased breast cancer risk. Continuous combined preparations were associated with the highest risk. Further studies are needed to disentangle the effects of the regimen and the progestin component.
125 citations
TL;DR: This impressive resource of existing birth cohort data could form the basis for longer-term and worldwide coordination of research on environment and child health.
Abstract: Background: Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improve collaboration, harmonization, and future project planning. Objectives: Our goal was to create a comprehensive overview of European birth cohorts with environmental exposure data. Methods: Birth cohort studies were included if they a) collected data on at least one environmental exposure, b) started enrollment during pregnancy or at birth, c) included at least one follow-up point after birth, d) included at least 200 mother-child pairs, and e) were based in a European country. A questionnaire collected information on basic protocol details and exposure and health outcome assessments, including specific contaminants, methods and samples, timing, and number of subjects. A full inventory can be searched on www.birthcohortsenrieco.net. Results: Questionnaires were completed by 37 cohort studies of > 350,000 mother-child pairs in 19 European countries. Only three cohorts did not participate. All cohorts collected biological specimens of children or parents. Many cohorts collected information on passive smoking (n = 36), maternal occupation (n = 33), outdoor air pollution (n = 27), and allergens/biological organisms (n = 27). Fewer cohorts (n = 12-19) collected information on water contamination, ionizing or nonionizing radiation exposures, noise, metals, persistent organic pollutants, or other pollutants. All cohorts have information on birth outcomes; nearly all on asthma, allergies, childhood growth and obesity; and 26 collected information on child neurodevelopment. Conclusion: Combining forces in this field will yield more efficient and conclusive studies and ultimately improve causal inference. This impressive resource of existing birth cohort data could form the basis for longer-term and worldwide coordination of research on environment and child health.
TL;DR: In this large cohort of postmenopausal women, BMI and physical activity had independent effects on hip fracture risk and physical inactivity was associated with an increased risk of hip fracture for women in every category of BMI.
Abstract: Hip fracture risk is known to increase with physical inactivity and decrease with obesity, but there is little information on their combined effects We report on the separate and combined effects of body mass index (BMI) and physical activity on hospital admissions for hip fracture among postmenopausal women in a large prospective UK study Baseline information on body size, physical activity, and other relevant factors was collected in 1996-2001, and participants were followed for incident hip fractures by record linkage to National Health Service (NHS) hospital admission data Cox regression was used to calculate adjusted relative risks of hip fracture Among 925,345 postmenopausal women followed for an average of 62 years, 2582 were admitted to hospital with an incident hip fracture Hip fracture risk increased with decreasing BMI: Compared with obese women (BMI of 30+ kg/m2), relative risks were 171 [95% confidence interval (CI) 147-197)] for BMI of 250 to 299 kg/m2 and 255 (95% CI 222-294) for BMI of 200 to 249 kg/m2 The increase in fracture risk per unit decrease in BMI was significantly greater among lean women than among overweight women (pa<001) For women in every category of BMI, physical inactivity was associated with an increased risk of hip fracture There was no significant interaction between the relative effects of BMI and physical activity For women who reported that they took any exercise versus no exercise, the adjusted relative risk of hip fracture was 068 (95% CI 062-075), with similar results for strenuous exercise In this large cohort of postmenopausal women, BMI and physical activity had independent effects on hip fracture risk © 2011 American Society for Bone and Mineral Research Copyright © 2011 American Society for Bone and Mineral Research
TL;DR: Further data are required, with better assays and repeat measures, to provide more accurate estimates of risk and to clarify the role of oestrogens in premenopausal women and the roles of other endogenous hormones.
TL;DR: Using a restricted source population for a cohort study will produce only relatively weak bias in estimates of the exposure–disease associations, under a range of sensible scenarios.
Abstract: Background Participants in cohort studies are frequently selected from restricted source populations. It has been recognised that such restriction may affect the study validity. Objectives To assess the bias that may arise when analyses involve data from cohorts based on restricted source populations, an area little studied in quantitative terms. Methods Monte Carlo simulations were used, based on a setting where the exposure and one risk factor for the outcome, which are not associated in the general population, influence selection into the cohort. All the parameters involved in the simulations (ie, prevalence and effects of exposure and risk factor on both the selection and outcome process, selection prevalence, baseline outcome incidence rate, and sample size) were allowed to vary to reflect real life settings. Results The simulations show that when the exposure and risk factor are strongly associated with selection (ORs of 4 or 0.25) and the unmeasured risk factor is associated with a disease HR of 4, the bias in the estimated log HR for the exposure–disease association is ±0.15. When these associations decrease to values more commonly seen in epidemiological studies (eg, ORs and HRs of 2 or 0.5), the bias in the log HR drops to just ±0.02. Conclusions Using a restricted source population for a cohort study will, under a range of sensible scenarios, produce only relatively weak bias in estimates of the exposure–disease associations.
TL;DR: Fatigue prevalence rates differed according to tumour stage, site, age, and sex of the patients, and can be used for the planning of research and clinical routine.
Abstract: Age- and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients
Cancer Epidemiology Unit1, Aarhus University2, Aalborg University3, Aarhus University Hospital4, German Cancer Research Center5, National and Kapodistrian University of Athens6, Harvard University7, Academy of Athens8, French Institute of Health and Medical Research9, Prevention Institute10, Utrecht University11, Imperial College London12, University of Tromsø13, Basque Government14, University of Cambridge15, International Agency for Research on Cancer16
TL;DR: Height and BMI are associated with IGF-I and its binding proteins, which may be mechanisms through which body size contributes to increased risk of several cancers.
Abstract: Background: Height and BMI are risk factors for several types of cancer and may be related to circulating concentrations of insulin-like growth factor-I (IGF-I), a peptide associated with increased cancer risk.Aim: To assess the associations between height, BMI and serum concentrations of IGF-I and IGF binding protein (IGFBP)-1, -2 and -3.Subjects and methods: This cross-sectional analysis included 1142 men and 3589 women aged 32–77 years from the multi-centre study, the European Prospective Investigation of Cancer and Nutrition (EPIC).Results: In men, there was a positive association between height and IGF-I; each 10 cm increment in height was associated with an increase in IGF-I concentrations of 4.3% (95% confidence interval (CI): 1.3–7.5%, p for trend = 0.005), but this association was not statistically significant for women (0.9%, 95% CI: − 0.7 to 2.6%, p for trend = 0.264). In both men and women, the association between IGF-I and BMI was non-linear and those with a BMI of 26–27 kg/m2 had the highest...
TL;DR: This study provides some evidence that self-reported data on certain anthropometric and reproductive factors may be adequate for describing disease-exposure associations in large epidemiological studies, provided that the effects of reporting errors are quantified and the results are interpreted with caution.
Abstract: Data on lifetime exposures are often self-reported in epidemiologic studies, sometimes many years after the relevant age. Validity of self-reported data is usually inferred from their agreement with measured values, but few studies directly quantify the likely effects of reporting errors in body size and reproductive history variables on estimates of disease-exposure associations. The MRC National Survey of Health and Development (NSHD) and the Million Women Study (MWS) are UK population-based prospective cohorts. The NSHD recruited participants at birth in 1946 and has followed them at regular intervals since then, whereas the MWS recruited women in middle age. For 541 women who were participants in both studies, we used statistical measures of association and agreement to compare self-reported MWS data on body size throughout life and reproductive history, obtained in middle age, to NSHD data measured or reported close to the relevant ages. Likely attenuation of estimates of linear disease-exposure associations due to the combined effects of random and systematic errors was quantified using regression dilution ratios (RDRs). Data from the two studies were very strongly correlated for current height, weight and body mass index, and age at menopause (Pearson r = 0.91-0.95), strongly correlated for birth weight, parental heights, current waist and hip circumferences and waist-to-height ratio (r = 0.67-0.80), and moderately correlated for age at menarche and waist-to-hip ratio (r = 0.52-0.57). Self-reported categorical body size and clothes size data for various ages were moderately to strongly associated with anthropometry collected at the relevant times (Spearman correlations 0.51-0.79). Overall agreement between the studies was also good for most quantitative variables, although all exhibited both random and systematic reporting error. RDRs ranged from 0.66 to 0.86 for most variables (slight to moderate attenuation), except weight and body mass index (1.02 and 1.04, respectively; little or no attenuation), and age at menarche, birth weight and waist-to-hip ratio (0.44, 0.59 and 0.50, respectively; substantial attenuation). This study provides some evidence that self-reported data on certain anthropometric and reproductive factors may be adequate for describing disease-exposure associations in large epidemiological studies, provided that the effects of reporting errors are quantified and the results are interpreted with caution.
TL;DR: Vegetarians were at lower risk of cataract than were meat eaters in this cohort of health-conscious British residents, and Associations betweenCataract risk and intakes of selected nutrients and foods generally reflected the strong association with diet group.
TL;DR: Smoke-free policies can constitute a simple and inexpensive intervention for the prevention of cardiovascular diseases and thus should be included in prevention programmes.
Abstract: Background
Several studies have reported a reduction in acute coronary events (ACEs) in the general population after the enforcement of smoking regulations, although there is uncertainty concerning the magnitude of the effect of such interventions. We conducted a country-wide evaluation of the health effects of the introduction of a smoking ban in public places, using data on hospital admissions for ACEs from the Italian population after the implementation of a national smoking regulation in January 2005.
TL;DR: Lampi et al. as mentioned in this paper investigated the association of a farming environment, especially farm animal contact, during infancy, with atopic sensitization and allergic diseases at the age of 31.
Abstract: Summary
Background Cross-sectional studies have shown an association between the farming environment and a decreased risk of atopic sensitization, mainly related to contact with farm animals in the childhood.
Objective Investigate the association of a farming environment, especially farm animal contact, during infancy, with atopic sensitization and allergic diseases at the age of 31.
Methods In a prospective birth cohort study, 5509 subjects born in northern Finland in 1966 were followed up at the age of 31. Prenatal exposure to the farming environment was documented before or at birth. At age 31, information on health status and childhood exposure to pets was collected by a questionnaire and skin prick tests were performed.
Results Being born to a family having farm animals decreased the risk of atopic sensitization [odds ratio (OR) 0.67; 95% confidence interval (CI) 0.56–0.80], atopic eczema ever (OR 0.77; 95% CI 0.66–0.91), doctor-diagnosed asthma ever (OR 0.74; 95% CI 0.55–1.00), allergic rhinitis at age 31 (OR 0.87; 95% CI 0.73–1.03) and allergic conjunctivitis (OR 0.86; 95% CI 0.72–1.02) at age 31. There was a suggestion that the reduced risk of allergic sensitization was particularly evident among the subjects whose mothers worked with farm animals during pregnancy, and that the reduced risk of the above diseases by farm animal exposure was largely explained by the reduced risk of atopy. Having cats and dogs in childhood revealed similar associations as farm animals with atopic sensitization.
Conclusion and Clinical Relevance Contact with farm animals in early childhood reduces the risk of atopic sensitization, doctor-diagnosed asthma and allergic diseases at age 31.
Cite this as: J. Lampi, D. Canoy, D. Jarvis, A.-L. Hartikainen, L. Keski-Nisula, M.-R. Jarvelin and J. Pekkanen, Clinical & Experimental Allergy, 2011 (41) 987–993.
TL;DR: A simple Monte Carlo model of the Siemens Primus 6 MV linac for both open and wedged fields is developed and validated with dose profiles measured in a water tank up to 30 cm from the central axis and an uncertainty of 50% in dose estimation could be acceptable in the context of risk assessment.
Abstract: Second cancer risk assessment for radiotherapy is controversial due to the large uncertainties of the dose–response relationship. This could be improved by a better assessment of the peripheral doses to healthy organs in future epidemiological studies. In this framework, we developed a simple Monte Carlo (MC) model of the Siemens Primus 6 MV linac for both open and wedged fields that we then validated with dose profiles measured in a water tank up to 30 cm from the central axis. The differences between the measured and calculated doses were comparable to other more complex MC models and never exceeded 50%. We then compared our simple MC model with the peripheral dose profiles of five different linacs with different collimation systems. We found that the peripheral dose between two linacs could differ up to a factor of 9 for small fields (5 × 5 cm2) and up to a factor of 10 for wedged fields. Considering that an uncertainty of 50% in dose estimation could be acceptable in the context of risk assessment, the MC model can be used as a generic model for large open fields (≥10 × 10 cm2) only. The uncertainties in peripheral doses should be considered in future epidemiological studies when designing the width of the dose bins to stratify the risk as a function of the dose.
TL;DR: Of the five established CL excesses near nuclear sites, four are associated with significant PM; in the fifth, the Krummel power station in Germany, the subject has not been thoroughly investigated.
Abstract: The excess of childhood leukaemia (CL) in Seascale, near the Sellafield nuclear reprocessing site in rural NW England, suggested that an epidemic of an underlying infection, to which CL is a rare response, is promoted by marked population mixing (PM) in rural areas, in which the prevalence of susceptibles is higher than average. This hypothesis has been confirmed by 12 studies in non-radiation situations. Of the five established CL excesses near nuclear sites, four are associated with significant PM; in the fifth, the Krummel power station in Germany, the subject has not been thoroughly investigated.
TL;DR: Certain occupations and industries have increased lung cancer risks in New Zealand, including wood workers, metal workers, meat workers, textile workers and drivers.
Abstract: Background There are many proven and suspected occupational causes of lung cancer, which will become relatively more important over time, as smoking prevalence decreases. Methods We interviewed 457 cases aged 20–75 years notified to the New Zealand Cancer Registry during 2007–2008, and 792 population controls. We collected information on demographic details, potential confounders, and employment history. Associations were estimated using logistic regression adjusted for gender, age, ethnicity, smoking, and socio-economic status. Results Among occupations of a priori interest, elevated odds ratios (ORs) were observed for sawmill, wood panel and related wood-processing plant operators (OR 4.63; 95% CI 1.05–20.29), butchers (OR 8.77, 95% CI 1.06–72.55), rubber and plastics products machine operators (4.27; 1.16–15.66), heavy truck drivers (2.24; 1.19–4.21) and workers in petroleum, coal, chemical and associated product manufacturing (1.80; 1.11–2.90); non-significantly elevated risks were also observed for loggers (4.67; 0.81–27.03), welders and flame-cutters (2.50; 0.86–7.25), pressers (5.74; 0.96–34.42), and electric and electronic equipment assemblers (3.61; 0.96–13.57). Several occupations and industries not of a priori interest also showed increased risks, including nursing associate professionals (5.45; 2.29–12.99), enrolled nurses (7.95; 3.10–20.42), care givers (3.47; 1.40–8.59), plant and machine operators and assemblers (1.61; 1.20–2.16), stationary machine operators and assemblers (1.67; 1.22–2.28), food and related products processing machine operators (1.98; 1.23–3.19), laborers and related elementary service workers (1.45; 1.05–2.00), manufacturing (1.34; 1.02–1.77), car retailing (3.08; 1.36–6.94), and road freight transport (3.02; 1.45–6.27). Conclusions Certain occupations and industries have increased lung cancer risks in New Zealand, including wood workers, metal workers, meat workers, textile workers and drivers. Am. J. Ind. Med. 54:89–101, 2011. 2010 Wiley-Liss, Inc.
TL;DR: Papers from different countries published in the same journal have different citation rates, which may reflect difficulties for researchers from some countries to publish their research in leading medical journals.
Abstract: Background The acceptance of a paper in a top-ranked journal depends on the importance of the study, and should not depend on its country of origin. If the papers9 citation rate is a proxy for their importance, and the threshold for acceptance is unrelated to the country of origin, papers from different countries published in the same journal should have a similar number of citations. Conversely, if the threshold is lowered for some countries, their papers will have a lower mean citation rate. Methods The number of citations and the corresponding author9s country were obtained for 4724 papers published between 1998 and 2002 in the British Medical Journal , the Lancet , Journal of the American Medical Association and New England Journal of Medicine . Countries were grouped according to the World Bank classification and geographical location: low–middle income countries; high-income European countries; high-income non-European countries; UK and USA. The probability of papers being poorly cited by country of origin was estimated, using domestic papers (British papers published in British journals and US papers published in US journals) as the reference. Results Compared with domestic papers, the OR of being poorly cited was 0.67 (95% CI 0.55 to 0.81) for papers from high-income European countries, 0.97 (0.76 to 1.24) for papers from high-income non-European countries and 1.93 (1.28 to 2.89) for papers from low–middle income countries. Conclusions Papers from different countries published in the same journal have different citation rates. This may reflect difficulties for researchers from some countries to publish their research in leading medical journals.
TL;DR: An empirical model for exposure to respirable crystalline silica (RCS) was described to create a quantitative job-exposure matrix (JEM) for community-based studies and indicated an overall downward time trend in RCS exposure levels of -6% per year.
Abstract: We describe an empirical model for exposure to respirable crystalline silica (RCS) to create a quantitative job-exposure matrix (JEM) for community-based studies. Personal measurements of exposure to RCS from Europe and Canada were obtained for exposure modelling. A mixed-effects model was elaborated, with region/country and job titles as random effect terms. The fixed effect terms included year of measurement, measurement strategy (representative or worst-case), sampling duration (minutes) and a priori exposure intensity rating for each job from an independently developed JEM (none, low, high). 23640 personal RCS exposure measurements, covering a time period from 1976 to 2009, were available for modelling. The model indicated an overall downward time trend in RCS exposure levels of −6% per year. Exposure levels were higher in the UK and Canada, and lower in Northern Europe and Germany. Worst-case sampling was associated with higher reported exposure levels and an increase in sampling duration was associated with lower reported exposure levels. Highest predicted RCS exposure levels in the reference year (1998) were for chimney bricklayers (geometric mean 0.11 mg m−3), monument carvers and other stone cutters and carvers (0.10 mg m−3). The resulting model enables us to predict time-, job-, and region/country-specific exposure levels of RCS. These predictions will be used in the SYNERGY study, an ongoing pooled multinational community-based case-control study on lung cancer.
TL;DR: This pilot study has informed the randomized phasing-in of the age extension across the whole of England and found no major problems of feasibility or acceptability of randomization were found.
Abstract: ObjectiveTo assess the feasibility and acceptability of randomizing the phased introduction of the extension of the invited age range in the National Health Service (NHS) Breast Screening Programme in England from 50-70 to 47-73 years.SettingSix volunteer breast screening units (BSUs) in England.MethodsCluster-randomized trial of invitation versus no invitation for breast screening. Study participants: women aged 47-49 and 71-73 years in screening batches randomized between 1 June 2009 and 31 May 2010. Outcomes: workload, screening uptake among women invited, self-referrals among women not invited, and screening outcomes among women invited.ResultsA total of 312 screening batches (clusters) were randomized including 60,708 women. Screening uptake was 63% in women aged 47-49 and 62% in women aged 71-73. Those who attended screening in the younger age group were more likely to be recalled for assessment than older attendees (7.5% vs. 3.0%) but less likely to be diagnosed with breast cancer (0.5% vs. 1.1%). ...
TL;DR: Support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer, and the attitudes of clinicians are studied.
Abstract: Background:There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians.
Objective: To examine specialist breast clinicians’ opinions about the provision of decision support interventions (DesIs) for patients.
Methods: As part of the development of a web-based DesI (BresDex), semi-structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach.
Results: A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients’ needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role.
Conclusions: The concept of providing interventions to support patients in decision-making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice.
TL;DR: In this study, breast cancer risk was not associated with fat intake in middle-aged women in the United Kingdom, irrespective of whether diet was measured by food diaries or by FFQs.
TL;DR: The association of MPM with DNA repair genes support the hypothesis that an increased susceptibility to DNA damage may favour asbestos carcinogenicity.
Abstract: Malignant pleural mesothelioma (MPM) is a rare aggressive tumor associated with asbestos exposure. The possible role of genetic factors has also been suggested and MPM has been associated with single nucleotide polymorphisms (SNPs) of xenobiotic and oxidative metabolism enzymes. We have identified an association of the DNA repair gene XRCC1 with MPM in the population of Casale Monferrato, a town exposed to high asbestos pollution. To extend this observation we examined 35 SNPs in 15 genes that could be involved in MPM carcinogenicity in 220 MPM patients and 296 controls from two case-control studies conducted in Casale (151 patients, 252 controls) and Turin (69 patients, 44 controls), respectively. Unconditional multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Two DNA repair genes were associated with MPM, i.e. XRCC1 and ERCC1. Considering asbestos-exposed only, the risk increased with the increasing number of XRCC1-399Q alleles (Casale: OR=1.44, 95%CI 1.02-2.03; Casale+Turin: OR=1.34, 95%CI 0.98-1.84) or XRCC1 -77T alleles (Casale+Turin: OR=1.33, 95%CI 0.97-1.81). The XRCC1-TGGGGGAACAGA haplotype was significantly associated with MPM (Casale: OR=1.76, 95%CI 1.04-2.96). Patients heterozygotes for ERCC1 N118N showed an increased OR in all subjects (OR=1.66, 95%CI 1.06-2.60) and in asbestos-exposed only (OR=1.59, 95%CI 1.01-2.50). When the dominant model was considered (i.e. ERCC1 heterozygotes CT plus homozygotes CC versus homozygotes TT) the risk was statistically significant both in all subjects (OR=1.61, 95%CI 1.06-2.47) and in asbestos-exposed only (OR=1.56, 95%CI 1.02-2.40). The combination of ERCC1 N118N and XRCC1 R399Q was statistically significant (Casale: OR=2.02, 95%CI 1.01-4.05; Casale+Turin: OR=2.39, 95%CI 1.29-4.43). The association of MPM with DNA repair genes support the hypothesis that an increased susceptibility to DNA damage may favour asbestos carcinogenicity.
TL;DR: The burden of malignant and benign cutaneous disease among renal transplant recipients (RTR) is substantial and little attention is given to non‐malignant skin problems in the literature despite their potential impact on quality of life or on aesthetics.
Abstract: Background The burden of malignant and benign cutaneous disease among renal transplant recipients (RTR) is substantial. Little attention is given to non-malignant skin problems in the literature despite their potential impact on quality of life or on aesthetics – which may contribute to poor compliance with immunosuppressive medications post-transplantation.
Objectives The aim of this study was to examine prevalence of benign cutaneous disease in a group of RTRs and identify risk factors for individual cutaneous conditions.
Methods All cutaneous findings were recorded in a single full body skin examination of 308 RTRs. Data on medical, transplant and medication history were obtained from questionnaire and medical records. Odds ratios were calculated to look at associations between benign cutaneous diseases and various potential risk factors after controlling for gender, age, time since transplantation and skin type.
Results Cutaneous infections such as viral warts (38%), fungal infection (18%) and folliculitis (27%) were common and usually chronic. A range of pilosebaceous unit disorders were observed with hypertrichosis being strongly associated with ciclosporin (P < 0.0001). Other iatrogenic cutaneous effects included gingival hyperplasia (27%) and purpura (41%). We identified seborrhoeic warts and skin tags in 55% and 33% respectively. Inflammatory dermatoses were rare (< 2%) apart from seborrhoeic dermatitis (9.5%).
Discussion In this first comprehensive study on prevalence of benign cutaneous diseases in a UK transplant population, a wide range of skin disorders was identified. It is therefore important that RTRs have access to dermatology services post-transplantation for appropriate management of benign cutaneous conditions as well as early detection of cutaneous malignancy and education regarding risks of sun exposure.