Proportion of cancer cases and deaths attributable to lifestyle risk factors in Brazil

BackgroundLifestyle risk factors (tobacco smoking, alcohol consumption, overweight and obesity, unhealthy diet, and lack of physical activity) have been associated with increased risk of at least 20 types of cancer. We estimated the proportion of cancer cases and deaths that could be potentially avoided by eliminating or reducing lifestyle risk factors in Brazil.MethodsWe obtained the distribution of lifestyle risk factors by sex and age groups from recent representative health surveys in Brazil; relative risks from pooled analyses of prospective studies and meta-analyses; and cancer cases and deaths in 2012 from GLOBOCAN.ResultsWe found that 26.5% (114,497 cases) of all cancer cases and 33.6% (63,371 deaths) of all cancer deaths could be potentially avoided by eliminating lifestyle risk factors in Brazil. Plausible reductions in these exposures based on policy targets and cancer prevention recommendations could have potentially avoided 4.5% (19,731 cases) and 6.1% (11,480 deaths) of all cancer cases and deaths, respectively. Tobacco smoking accounted for most of the preventable cancer cases and deaths, followed by high body mass index and alcohol consumption. Larynx, lung, oropharynx, esophagus and colorectum cancer cases and deaths could be at least halved by eliminating these lifestyle risk factors.ConclusionFindings from this study may be useful to inform strategies for cancer prevention and control across Brazil.     

Demographic,social and lifestyle risk factors for cancer registry-notified cancer of unknown primary site (CUP)

BackgroundLittle is known about the risk factors for cancer of unknown primary site (CUP). We examined the demographic, social and lifestyle risk factors for CUP in a prospective cohort of 266,724 people aged 45 years and over in New South Wales, Australia.MethodsBaseline questionnaire data were linked to cancer registration, hospitalisation, emergency department admission, and mortality data. We compared individuals with incident cancer registry-notified CUP (n = 327) to two sets of controls randomly selected (3:1) using incidence density sampling with replacement: (i) incident cancer registry-notified metastatic cancer of known primary site (n = 977) and (ii) general cohort population (n = 981). We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).ResultsIn a fully adjusted model incorporating self-rated overall health and comorbidity, people diagnosed with CUP were more likely to be older (OR 1.05, 95% CI 1.04–1.07 per year) and more likely to have low educational attainment (OR 1.77, 95% CI 1.24–2.53) than those diagnosed with metastatic cancer of known primary. Similarly, compared to general cohort population controls, people diagnosed with CUP were older (OR 1.10, 95% CI 1.08–1.12 per year), of low educational attainment (OR 1.69, 95% CI 1.08–2.64), and current (OR 3.42, 95% CI 1.81–6.47) or former (OR 1.95, 95% CI 1.33–2.86) smokers.ConclusionThe consistent association with educational attainment suggests low health literacy may play a role in CUP diagnosis. These findings highlight the need to develop strategies to achieve earlier identification of diagnostically challenging malignancies in people with low health literacy.     

The future excess fraction of cancer due to lifestyle factors in Australia

BackgroundMany cancers are caused by exposure to lifestyle, environmental, and occupational factors. Earlier studies have estimated the number of cancers occurring in a single year which are attributable to past exposures to these factors. However, there is now increasing appreciation that estimates of the future burden of cancer may be more useful for policy and prevention. We aimed to calculate the future number of cancers expected to arise as a result of exposure to 23 modifiable risk factors.MethodsWe used the future excess fraction (FEF) method to estimate the lifetime burden of cancer (2016–2098) among Australian adults who were exposed to modifiable lifestyle, environmental, and occupational risk factors in 2016. Calculations were conducted for 26 cancer sites and 78 cancer-risk factor pairings.ResultsThe cohort of 18.8 million adult Australians in 2016 will develop an estimated 7.6 million cancers during their lifetime, of which 1.8 million (24%) will be attributable to exposure to modifiable risk factors. Cancer sites with the highest number of future attributable cancers were colon and rectum (n = 717,700), lung (n = 380,400), and liver (n = 103,200). The highest number of future cancers will be attributable to exposure to tobacco smoke (n = 583,500), followed by overweight/obesity (n = 333,100) and alcohol consumption (n = 249,700).ConclusionA significant proportion of future cancers will result from recent levels of exposure to modifiable risk factors. Our results provide direct, pertinent information to help determine where preventive measures could best be targeted.     

Socioeconomic position and lifestyle in relation to breast cancer incidence among postmenopausal women: a prospective cohort study, Denmark, 1993-2006

Background: In Denmark, the incidence of breast cancer is higher among women with higher socioeconomic position. We investigated whether differences in exposure to certain risk factors contribute to this gradient, as measured from education, income and occupation. Methods: We conducted a cohort study of 23 111 postmenopausal women aged 50–65 years who were enrolled in the prospective Danish ‘Diet, Cancer and Health’ study between 1993 and 1995. At baseline, all women filled in a questionnaire on lifestyle and food frequency. The results were analysed in Cox proportional hazard models. Results: Part of the association with socioeconomic position is due to the potential mediators reproductive pattern, use of hormone replacement therapy and alcohol consumption. After simultaneous adjustment for these factors, the hazard ratios were 1.06 (95% confidence interval [CI], 0.88–1.27) for women with higher education and 1.07 (95% CI, 0.85–1.34) for women with higher income. The HR ratio for women working as higher officials when compared with unskilled workers was 1.23 (0.96–1.59). Conclusion: The results support the hypothesis that the higher incidence of breast cancer among socially advantaged women is mediated partly by differences in exposure to reproductive factors, hormone replacement therapy and alcohol.     

A national study of alcohol consumption patterns among population-based U.S. cancer survivors compared with cancer-free individuals

BackgroundThis study characterized alcohol consumption behaviors among adult cancer survivors and determined how these behaviors compared with cancer-free individuals using NHANES data (1999–2016).MethodsAdjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using multinomial logistic regression for the association between cancer survivors vs cancer-free individuals and odds of drinking status (former/current/never drinkers), accounting for demographic and socioeconomic factors. Among current drinkers, multivariable logistic regression was used to calculate the aORs for binge drinking and exceeding moderate drinking. Results: A total of 3113 survivors and 39,527 cancer-free individuals were included. Cancer survivors were less likely to be current drinkers (63.4% vs. 72.6% in cancer-free) and were more likely to be former drinkers (24.4% vs. 15.5% in cancer-free). Cancer survivors had significant lower odds of being current vs. never drinkers (aOR, 0.84, 95% CI: 0.71–0.99). By cancer types, cervical cancer survivors were more likely to be binge drinkers (aOR, 2.51, 95% CI: 1.27–4.92), particularly among women aged ≥ 55 years (aOR, 6.90, 95% CI: 1.28–37.3).ConclusionGiven the high odds of binge drinking among cervical cancer survivors, public health strategies are needed to reduce alcohol consumption in this group.     

Association of dietary risks,behavioural and lifestyle factors,and the magnitude of disability burden among Australian cancer patients: An observational epidemiology study

BackgroundCancer patients are confronted with a variety of other health-related issues, including physical disability, poor quality of life, and psychological challenges. This study aims to quantify the association of dietary, behavioural and lifestyle risk factors and comorbidities on the magnitude and distribution of disability burden among cancer patients in Australia.MethodsThis study comprised a sample of 2283 cancer patients drawn from the latest nationwide Australian National Health Survey conducted in 2017–18. Negative binomial regression models were used to estimate the incidence rate ratio (IRR) of the number of disabilities and its associations.ResultsForty-five percent of cancer patients experienced at least one disability. The magnitude of disability was significantly associated with sugar-sweetened drink consumption ≥ 3 days per week (IRR= 1.12, 95% CI: 1.02–1.26), a lack of physical activity (IRR = 1.69, 1.38–2.07), frequent or regular alcohol consumption (IRR = 1.95, 1.84–2.08), poor health status (IRR = 1.99, 1.78–2.24) and the presence of five or more chronic comorbid conditions (IRR = 3.59, 2.90–4.46). Cancer patients who consumed vegetables at least two or more times per day had a 10% lower risk of disability burden (IRR = 0.90, 0.82–0.99).ConclusionsThis study shows the association of diet, behavioural, and lifestyle risk factors on the degree of disability burden among cancer patients, highlighting the need for bold and effective policies. The findings will inform the implementation of evidence-based lifestyle interventions and offer a foundation for evaluating their influence on cancer survivors’ health.     

Predictors of behavioral cancer risk factors and preventive behaviors among Nebraskans

BackgroundThe overall incidence rate of cancer in Nebraska is higher than the national average with cancer being the second leading cause of death in the state. Interventions are required to reduce the cancer burden; however, further research is first needed to identify behavioral cancer risk factors and preventive behaviors among Nebraskans that can be targeted.MethodsA statewide cross-sectional survey of Nebraskans aged 19 and older was conducted in 2019 using an address-based sampling method (n = 1640). Multivariable logistic regression was used to examine factors associated with being up-to-date on cancer screening and with behavioral cancer risk factors and preventive behaviors.Results93.42% of Nebraskans did not meet the daily recommended consumption of fruits and vegetables, and 71.51% did not meet weekly physical activity guidelines. The proportion of adults up to date on cancer screening was 64.57% for breast, 68.83% for cervical, 69.01% for colorectal, and 24.07% for skin cancers. Individuals 65–74 (OR: 3.40, 95% CI: 1.52–7.62) and 75 or older (OR: 3.30, 95% CI: 1.35–8.07) were more likely to be current with their colorectal cancer screening compared to ages 50–64. Hispanics were less likely to be current with mammograms (OR: 0.06, 95% CI: 0.01–0.71) and ever screened for cervical cancer (OR:0.13, 95% CI: 0.02–0.94) compared to Non-Hispanic Whites.ConclusionsDisparities in cancer screening and risk and preventive behaviors exist in Nebraska.ImpactThe study highlights a need for continuing efforts to improve preventive cancer behaviors for the entire population as well as some high-risk populations in Nebraska.     

Healthy lifestyle and breast cancer risk: A case-control study in Morocco

BackgroundSome modifiable risk factors have been independently associated with breast cancer (BC) risk in Moroccan women, but no studies have investigated their joint association. This study aimed to investigate the association between a Healthy Lifestyle Index (HLI) score and BC risk among Moroccan women.MethodsIn this case–control study, 300 incident BC cases and 300 controls, matched by age and area of residence were recruited. Cases were women newly-diagnosed with histopathologically–confirmed BC at the University Hospital in Fez, Morocco. Controls were randomly selected healthy women recruited from 6 primary health centers in Fez. HLI scores developed within this study were assigned to participants based on 11 factors (red and processed meat, white meat, cream, cheese, fish, fruit and vegetables, physical activity, BMI, smoking, alcohol consumption, and breastfeeding), where 0 was given to unhealthy and 0.5 or 1 to healthy levels of each factor. Conditional and unconditional logistic regression models were used to assess the association between HLI scores and BC risk.ResultsMean of HLI scores were 8.1 (±1.1) and 9.0 (±0.9) in cases and controls, respectively, p < 0.01. After adjusting for potential confounders, one-point increment in the HLI score was associated with 56% (95% CI, CI: 39–68%), 49% (95% CI: 30–63%), and 59% (95% CI: 40–72%) lower risks of BC in all, premenopausal, and postmenopausal women, respectively.ConclusionHigh HLI scores were associated with decreased risk of BC in Moroccan women. These findings suggest that BC prevention policies should include strategies for engaging Moroccan women in healthy lifestyles.     

Melanoma,Growth Factors,and Cutaneous Paraneoplastic Syndromes

Paraneoplastic syndromes are systemic reactions in patients with cancers that are unrelated to tumor size or location. Cutaneous paraneoplastic syndromes include proliferative, metabolic, and inflammatory skin disorders. Both systemic and cutaneous paraneoplastic reactions may occur in patients with malignant melanoma. Cancers, including melanoma, may produce growth factors, which may be responsible for proliferative cutaneous paraneoplastic syndromes. A patient with malignant melanoma we previously reported, who had the sudden onset of acanthosis nigricans, skin tags (acrochordons), and seborrheic keratoses provides a model for proliferative cutaneous paraneoplastic syndromes. High levels of α-TGF were found in the patient's urine prior to melanoma removal. The increased level of α-TGF declined after the melanoma was removed, and a corresponding clinical improvement in his acanthosis nigricans, skin tags, and seborrheic keratoses occurred. In the skin lesions, EGF receptors were abnormally present throughout all epidermal layers prior to melanoma removal, and returned to their normal distribution in the basal layers after surgery. Ectopic growth factor production by malignant melanomas and other epithelial neoplasms may cause rare, but distinctive cutaneous paraneoplastic lesions. The model of melanoma, cutaneous paraneoplastic syndromes, and growth factors may provide understanding of both cutaneous lesions associated with neoplasia, and benign cutaneous lesions.     

Incidence,prevalence, mortality,disability-adjusted life years and risk factors of cancer in Australia and comparison with OECD countries, 1990–2015: findings from the Global Burden of Disease Study 2015

BackgroundComparative evidence on the burden, trend, and risk factors of cancer is limited. Using data from the Global Burden of Disease (GBD) study, we aimed to assess cancer burden – incidence, prevalence, mortality, disability-adjusted life years (DALYs) – and attributable risk factors for Australia between 1990 and 2015, and to compare them with those of 34 members of the Organisation for Economic Co-operation and Development (OECD).MethodsThe general GBD cancer estimation methods were used with data input from vital registration systems and cancer registries. A comparative risk assessment approach was used to estimate the population-attributable fractions due to risk factors.ResultsIn 2015 there were 198,880 (95% uncertainty interval [UI]: 183,908–217,365) estimated incident cancer cases and 47,562 (95% UI: 46,061–49,004) cancer deaths in Australia. Twenty-nine percent (95% UI: 28.2–29.8) of total deaths and 17.0% (95% UI: 15.0–19.1) of DALYs were caused by cancer in Australia in 2015. Cancers of the trachea, bronchus and lung, colon and rectum, and prostate were the most common causes of cancer deaths. Thirty-six percent (95% UI: 33.1–37.9) of all cancer deaths were attributable to behavioral risks. The age-standardized cancer incidence rate (ASIR) increased between 1990 and 2015, while the age-standardized cancer death rate (ASDR) decreased over the same period. In 2015, compared to 34 other OECD countries Australia ranked first (highest) and 24^th based on ASIR and ASDR, respectively.ConclusionThe incidence of cancer has increased over 25 years, and behavioral risks are responsible for a large proportion of cancer deaths. Scaling up of prevention (using strategies targeting cancer risk factors), early detection, and treatment of cancer is required to effectively address this growing health challenge.     

Studying health histories of cancer: A new model connecting cancer incidence and survival

The results of recent experimental and epidemiological studies provide evidence on the connection between carcinogenesis, cancer progression, and aging. Existing models, however, are traditionally focused only on one of these aspects of health deterioration. In this paper, we derive a new model of cancer, which describes the connection between the ages at disease onset, the duration of disease, and life span of respective individuals. The model combines ideas used in the two hits model of carcinogenesis with those used in the Le Bras multistate model of aging with constant transition intensities. The model is used in the joint analyses of the US demographic mortality data and SEER data for selected cancers. The results show that the developed approach is capable of explaining links among health history data and provides useful insights on mechanisms of cancer occurrence, disease progression, other aging-related changes, and mortality. Further developments of this model are discussed.     

Nutrition, metabolism and colorectal cancer

Colorectal cancer and myocardial infarction are associated at population level and in autoptic studies. Furthermore, they share many blood variables: cholesterol, triglycerides and HDL cholesterol, fructosamine, glycated haemoglobin and glycated apolipoprotein B. These blood variables are intermediates between dietary, mainly saturated fats and high glycemic index and load diets, and colorectal cancer and myocardial infarction. Blood intermediate variables can be used in dietary trials as outcomes, and even to throw light on the pathogenesis of both diseases.     

Carcinogen-DNA adducts as a biomarker for cancer risk

Carcinogen-DNA adducts are thought to be a useful biomarker in epidemiologic studies seeking to show that environmental exposures to xenobiotics cause cancer. This paper reviews the literature in this field from an epidemiologic perspective and identifies several common problems in the epidemiologic design and analysis of these studies. Carcinogen-DNA adducts have been used in studies attempting to link xenobiotic exposures to hepatocellular carcinoma, smoking related cancers and breast cancer. Adduct measurements have been useful in further implicating aflatoxin exposure in the etiology of hepatocellular carcinoma. For smoking related cancers, associations with carcinogen-DNA adducts are commonly seen in current smokers but less so in ex- or non-smokers. In breast cancer the associations have been inconsistent and weak and there is little evidence that carcinogen-DNA adducts implicate xenobiotic exposures in the etiology of breast cancer. Methodological issues common to these studies are the use of target versus surrogate tissues and how this choice impacts control selection, disease effects on adduct levels, the time period reflected by adduct levels, the use of inappropriate statistical analyses and small sample sizes. It is unclear whether the lack of association between carcinogen-DNA adducts and cancer reflects a lack of association between the xenobiotic exposure of interest and cancer or the effects of these methodological issues. A greater focus needs to be placed on designs that allow measurements of adduct levels in tissues collected years prior to cancer diagnosis, there is little need for further hospital based case-control studies in which adducts are measured at the time of or after diagnosis. New designs that address these issues are suggested in the paper.     

Risk factors for patient-reported errors during cancer follow-up: Results from a national survey in Denmark

Due to an increased cancer survival, more cancer patients are referred to follow-up after primary treatment. Knowledge of patient safety during follow-up is sparse.ObjectiveTo examine patient-reported errors during cancer follow-up and identify factors associated with errors.DesignA national survey on cancer patients’ experiences of treatment and aftercare was conducted in 2012, about two years following cancer diagnosis (N = 6914). Associations between patient-reported errors during follow-up and covariates were examined using multiple logistic regression. Qualitative responses were analysed using text analysis.ResultsThis study included 3731 patients, representing a response rate of 64%. Overall, 27.6% of patients reported at least one error during cancer follow-up. 11.7% reported that important information was missing at follow-up consultations; 9.8% were not called in for a follow-up as expected; 16.7% reported that the doctor/nurse handling the follow-up consultation were ill-prepared on their course of disease. Other errors were reported by 4.7%. Patients who reported errors in follow-up were more likely to report an error or complication during primary cancer treatment, not having one health professional with oversight and responsibility for their overall follow-up pathway, be younger, have a diagnosis of rare cancer, poorer self-rated health and high usage of healthcare services.ConclusionWorkflows related to handling of test results, referrals, bookings and medical records have to be improved. Introduction of one particular healthcare professional responsible for the patients’ follow-up may result in fewer patient-reported errors however interventions are needed to examine this. Patients prone to errors should be subject to particular attention.     

Kallikarein-related peptidase 3 common genetic variant and the risk of prostate cancer

Kallikarein-related peptidase 3 (KLK3) gene polymorphisms seem to play a role in susceptibility to prostate cancer (PC). The purpose of this study was to investigate the association between rs2735839 polymorphism of KLK3 gene and risk of PC in an Iranian population. In this case-control study, rs2735839 was genotyped in 532 patients with PC and 602 controls with benign prostate hyperplasia (BPH) using polymerase chain reaction-restriction fragment length polymorphism assay. The frequency of GG, AG, and AA genotypes of KLK3 polymorphism was 24.6% and 76.2%, 46.6% and 21.7%, and 28.8% and 2.1%, in patients with BPH and PC, respectively (P < 0.001). The frequency of G allele in patients with BPH and PC was 47.9% and 87%, respectively (odds ratio: 7.31; confidence interval: 5.88-9.10; P < 0.001). Patients with AG and GG genotypes had a higher total serum level of prostate-specific antigen (PSA) compared to those with AA genotype (P < 0.001). Patients with this polymorphism had higher risk of tumor with higher grade (P = 0.23), advanced stage (P = 0.11), perineural invasion (P = 0.07), and vascular invasion (P = 0.07) compared to those without it but this difference was not statistically significant. Based on our results, KLK3 gene polymorphism was associated with the risk of PC. Higher levels of PSA in the presence of KLK3 polymorphism in patients with PC indicated that rs2735839 polymorphism could be a risk factor for increased levels of PSA.     

The risk of cancer development in systemic sclerosis: A meta-analysis

Objectives: Systemic sclerosis is a multi-system disorder of connective tissue characterized by Raynaud's phenomenon and fibrosis of various organs. The risk of development of cancer in systemic sclerosis (SSc) has been extensively investigated with inconclusive results. To shed some light on the controversy, we conducted a meta-analysis of all published articles linking SSc to the risk of cancer development. Methods: Relevant electronic databases were searched for English-language studies characterizing the association of cancers in patients with SSc. Standardized incidence rate (SIR) with its 95% confidence interval (CI) of each study was combined using a fixed/random effect model. Results: A total of seven papers including 7183 SSc patients were identified, of which 7 reported the SIR for lung cancer, 4 for non-Hodgkin's lymphoma (NHL) and 4 for hematopoietic cancer and 7 for breast cancer. Compared with the general population, the combined SIR was 3.14 (95% CI: 2.02–4.89), 2.68 (95% CI: 1.58–4.56), 2.57 (95% CI: 1.79–3.68) and 1.09 (95% CI: 0.86–1.38), respectively. Significant heterogeneity was observed in lung cancer group (Q = 26.13, P < 0.001, I² = 77%). Potential publication bias was absent. Conclusions: This present meta-analysis demonstrated an increased risk of lung, non-Hodgkin's lymphoma and hematopoietic cancers among patients with SSc, but not for breast cancer. However, some of the available data were several decades old, and future studies taking new treatment strategies into account are required.     

Chromosomal aberrations and SCEs as biomarkers of cancer risk

Previous studies have suggested that the frequency of chromosomal aberrations (CAs), but not of sister chromatid exchanges (SCEs), predicts cancer risk. We have further examined this relationship in European cohorts comprising altogether almost 22,000 subjects, in the framework of a European collaborative project (CancerRiskBiomarkers). The present paper gives an overview of some of the results of the project, especially as regards CAs and SCEs. The results confirm that a high level of CAs is associated with an increased risk of cancer and indicate that this association does not depend on the time between CA analysis and cancer detection, i.e., is obviously not explained by undetected cancer. The present evidence indicates that both chromatid-type and chromosome-type CAs predict cancer, even though some data suggest that chromosome-type CAs may have a more pronounced predictive value than chromatid-type CAs. CA frequency appears to predict cancers at various sites, although there seems to be a particular association with gastrointestinal cancers. SCE frequency does not appear to have cancer predictive value, at least partly due to uncontrollable technical variation. A number of genetic polymorphisms of xenobiotic metabolism, DNA repair, and folate metabolism affect the level of CAs and might collectively contribute to the cancer predictivity of CAs. Other factors that may influence the association between CAs and cancer include, e.g., exposure to genotoxic carcinogens and internal generation of genotoxic species. Although the association between CA level and cancer is seen at the group level, an association probably also exists for the individual, although it is not known if an individual approach could be feasible. However, group level evidence should be enough to support the use of CA analysis as a tool in screening programs and prevention policies in occupational and environmental health.     

The relation between resting heart rate and cancer incidence,cancer mortality and all-cause mortality in patients with manifest vascular disease

BackgroundPrevious studies suggest that elevated resting heart rate (RHR) is related to an increased risk of cancer mortality. The aim of this study was to evaluate the relation between RHR and cancer incidence and mortality in patients with vascular disease.MethodsPatients with manifest vascular disease (n = 6007) were prospectively followed-up for cancer incidence and mortality. At baseline, RHR was obtained from an electrocardiogram. The relation between RHR and cancer incidence, cancer mortality and total mortality was assessed using competing risks models.ResultsDuring a median follow-up of 6.0 years (interquartile range: 3.1–9.3) 491 patients (8%) were diagnosed with cancer and 907 (15%) patients died, 248 (27%) died from cancer. After adjustment for potential confounders, the hazard ratio (HR) for incident cancer per 10 beats/min increase in RHR was 1.00 (95% confidence interval [CI]: 0.93–1.07). There was a trend toward an increased risk of colorectal cancer in patients with higher RHR (HR 1.15, 95% CI 0.97–1.36). The risk of all-cause mortality was increased in patients in the highest quartile of RHR compared to the lowest quartile (HR 1.86, 95% CI 1.53–2.27), but no effect of RHR on cancer mortality was observed (HR 1.01, 95% CI 0.70–1.46).ConclusionsIn patients with manifest vascular disease, elevated RHR was related to a higher risk of premature all-cause mortality, but this was not due to increased cancer mortality. RHR was not related to risk of overall cancer incidence, although a relation between elevated RHR and incident colorectal cancer risk could not be ruled out.