The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019

Insulin resistance and cancer: molecular links and clinical perspectives

The association between insulin resistance (IR), type 2 diabetes mellitus (T2DM), and cancer is increasingly recognized and poses an escalating global health challenge, as the incidence of these conditions continues to rise. Studies indicate that individuals with T2DM have a 10-20% increased risk of developing various solid tumors, including colorectal, breast, pancreatic, and liver cancers. The relative risk (RR) varies depending on cancer type, with pancreatic and liver cancers showing a particularly strong association (RR 2.0-2.5), while colorectal and breast cancers demonstrate a moderate increase (RR 1.2-1.5). Understanding these epidemiological trends is crucial for developing integrated management strategies. Given the global rise in T2DM and cancer cases, exploring the complex relationship between these conditions is critical. IR contributes to hyperglycemia, chronic inflammation, and altered lipid metabolism. Together, these factors create a pro-tumorigenic environment conducive to cancer development and progression. In individuals with IR, hyperinsulinemia triggers the insulin-insulin-like growth factor (IGF1R) signaling pathway, activating cancer-associated pathways such as mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PIK3CA), which promote cell proliferation and survival, thereby supporting tumor growth. Both IR and T2DM are linked to increased morbidity and mortality in patients with cancer. By providing an in-depth analysis of the molecular links between insulin resistance and cancer, this review offers valuable insights into the role of metabolic dysfunction in tumor progression. Addressing insulin resistance as a co-morbidity may open new avenues for risk assessment, early intervention, and the development of integrated treatment strategies to improve patient outcomes.

Cancer burden in Europe: a systematic analysis of the GLOBOCAN database (2022)

BACKGROUND

Cancer remains a significant public health challenge in Europe, with substantial regional disparities in incidence, mortality, and access to healthcare. This study analyses cancer patterns across Eastern, Northern, Southern, and Western Europe in 2022, highlighting key public health implications and gaps in prevention and treatment.

METHODS

Using data from GLOBOCAN 2022, this study assessed total new cancer cases, age-standardized incidence and mortality rates (ASRs) per 100,000, and cumulative cancer risk at age 75. The top three cancers by sex and region were also analysed to identify trends and disparities.

RESULTS

In 2022, Europe recorded 4,471,422 new cancer cases (ASR 280 per 100,000), with a cumulative risk of 27.9% by age 75. Males accounted for 2,359,303 cases (ASR 319.6, cumulative risk 31.9%), while females had 2,112,119 cases (ASR 253.4, cumulative risk 24.7%). Northern and Western Europe had the highest incidence rates, with Denmark leading at 374.7 per 100,000 (cumulative risk 34.9%), likely due to advanced screening and healthcare. Conversely, Eastern Europe had the highest mortality, with 1,091,871 deaths (ASR 135.3), reflecting late diagnoses and limited access of treatment. Hungary exhibited the highest mortality rate (ASR 143.7, cumulative risk 15.8%), followed by Poland (ASR 133.1). Prostate and breast cancers were the most common in males and females, respectively. Lung cancer, despite a lower incidence (ASR 24.7), had the highest mortality (ASR 17.7), while pancreatic cancer showed high fatality (ASR 6.3, mortality ASR 5.6). Thyroid cancer had a relatively high incidence (ASR 7.5) but low mortality (ASR 0.21).

CONCLUSIONS

Significant regional disparities in cancer burden underscore the need for targeted public health strategies. Expanding cancer screening programs, strengthening smoking cessation and HPV vaccination efforts, and improving healthcare accessibility particularly in Eastern Europe are critical to reducing mortality and enhancing early detection. Differences in mortality-to-incidence ratios also highlight the role of healthcare infrastructure and timely interventions. Future research should explore the socioeconomic and environmental determinants driving these disparities to inform evidence-based cancer control policies across Europe.

The effects of smoking, alcohol consumption, obesity, and physical inactivity on healthcare costs: a longitudinal cohort study

BACKGROUND

Research indicates major risk factors including smoking, alcohol consumption, obesity and physical inactivity contribute significantly to global disease burden and healthcare costs. However, these studies have challenges, such as increased bias and uncertainty arising from use of population attributable fractions (PAF) and the issue of reverse causality in cross-sectional data. This study aims to evaluate the long-term healthcare costs associated with these behaviors using a longitudinal cohort.

METHODS

This longitudinal cohort study used the Korean National Health Insurance Service-National Sample Cohort database (NHIS-NSC 2.0), covering 2002-2019. The cohort included individuals aged 40-69 years who underwent health examinations in 2002-2004 and had no pre-existing risk factor-related diseases. Cumulative healthcare costs during 2010-2019 were analyzed using a generalized linear model with log-link function and gamma distribution, adjusted for other health behaviors and sociodemographic factors.

RESULTS

Smoking, alcohol consumption, obesity, and physical inactivity significantly increased healthcare costs for both sexes. Male current smokers incurred 13.8% higher costs than never-smokers, while female smokers spent 18.6% more. Former smokers had lower costs than current smokers, with reductions of 9.9% for males and 13.2% for females. Almost daily alcohol consumption raised costs by 21.4% for males and 31.8% for females. Costs varied by BMI categories, with severe obesity increasing expenditures by 26.9% for males and 46.5% for females compared to normal weight. Overweight status showed contrasting effects between sexes, with a 3.4% decrease in healthcare costs for males but a 7.6% increase for females. Exercising 1-4 times weekly reduced costs by 7.6% for males and 7.4% for females compared to non-exercisers.

CONCLUSIONS

The study underscores the economic impact of health risk behaviors and supports the need for targeted public health interventions. The findings highlight the importance of targeted interventions for high-risk groups for reducing healthcare costs.

Projections for prevalence of Parkinson's disease and its driving factors in 195 countries and territories to 2050: modelling study of Global Burden of Disease Study 2021

OBJECTIVE

To predict the global, regional, and national prevalence of Parkinson's disease by age, sex, year, and Socio-demographic Index to 2050 and quantify the factors driving changes in Parkinson's disease cases.

DESIGN

Modelling study.

DATA SOURCE

Global Burden of Disease Study 2021.

MAIN OUTCOME MEASURES

Prevalent number, all age prevalence and age standardised prevalence of Parkinson's disease in 2050, and average annual percentage change of prevalence from 2021 to 2050; contribution of population ageing, population growth, and changes in prevalence to the growth in Parkinson's disease cases; population attributable fractions for modifiable factors.

RESULTS

25.2 (95% uncertainty interval 21.7 to 30.1) million people were projected to be living with Parkinson's disease worldwide in 2050, representing a 112% (95% uncertainty interval 71% to 152%) increase from 2021. Population ageing (89%) was predicted to be the primary contributor to the growth in cases from 2021 to 2050, followed by population growth (20%) and changes in prevalence (3%). The prevalence of Parkinson's disease was forecasted to be 267 (230 to 320) cases per 100 000 in 2050, indicating a significant increase of 76% (56% to 125%) from 2021, whereas the age standardised prevalence was predicted to be 216 (168 to 281) per 100 000, with an increase of 55% (50% to 60%) from 2021. Countries in the middle fifth of Socio-demographic Index were projected to have the highest percentage increase in the all age prevalence (144%, 87% to 183%) and age standardised prevalence (91%, 82% to 101%) of Parkinson's disease between 2021 and 2050. Among Global Burden of Disease regions, East Asia (10.9 (9.0 to 13.3) million) was projected to have the highest number of Parkinson's disease cases in 2050, with western Sub-Saharan Africa (292%, 266% to 362%) experiencing the most significant increase from 2021. The ≥80 years age group was projected to have the greatest increase in the number of Parkinson's disease cases (196%, 143% to 235%) from 2021 to 2050. The male-to-female ratios of age standardised prevalence of Parkinson's disease were projected to increase from 1.46 in 2021 to 1.64 in 2050 globally.

CONCLUSIONS

By 2050 Parkinson's disease will have become a greater public health challenge for patients, their families, care givers, communities, and society. The upward trend is expected to be more pronounced among countries with middle Socio-demographic Index, in the Global Burden of Disease East Asia region, and among men. This projection could serve as an aid in promoting health research, informing policy decisions, and allocating resources.

Temporal trend of breast cancer burden among younger and older Brazilian women, 1990-2019

OBJECTIVE

To analyze the temporal trend of the burden of breast cancer in Brazilian women under 40 years of age compared to the age group over 40 years of age, between 1996 and 2019.

METHODS

An ecological time trend study was conducted in Brazil between 1996 and 2019 using data from the Global Burden of Disease (GBD) study. The segmented regression method (Joinpoint Regression) was applied to analyze rates among women under and over 40 years of age. To capture differences in the level and trend of mortality and DALYs, the rate ratio was calculated for the two groups on a year-by-year basis.

RESULTS

Regarding DALY, an average annual decline of 0.7% (95%CI -0.8 to -0.5, p<0.01) was observed among women over 40 years old, while an annual increase of 1.0% (95%CI 0.9 to 1.1, p<0.001) was noted for women up to 40 years old. For mortality, the decline among older women was 0.3% per year (95%CI -0.4 to -0.2, p<0.001), and the increase among young women was 0.8% per year (95%CI 0.7 to 1.0, p<0.001). The average rate ratio for DAILY was 5.2, while for mortality, the average rate ratio was 8.1.

CONCLUSION

the analysis reinforces the idea that the magnitude and trend of breast cancer mortality among young women is a health issue requiring attention from health decision-makers. This diagnosis underscores the importance of initiating discussions on the need to review population screening criteria, incorporating clinical prediction rules.

Mortality of Head and Neck Cancer in China From 1990 to 2019: A Secondary Data Analysis

BACKGROUND

The rising global incidence of head and neck cancer imposes a growing burden on health systems. However, comprehensive analysis of mortality trends, particularly age, period, and cohort effects, remains limited.

OBJECTIVE

This study aims to evaluate head and neck cancer mortality trends in China from 1990 to 2019, with a focus on age, period, and cohort effects.

METHODS

A secondary data analysis was conducted using data from the Global Burden of Disease Study, focusing on the Chinese population aged 20 years and older. The cancers examined included those of the lip-oral cavity, nasopharynx, other pharynx, larynx, and thyroid. Mortality data, including death numbers and age-standardized rates, were analyzed using joinpoint regression and age-period-cohort analysis to identify trends.

RESULTS

The study revealed that from 1990 to 2019, the age-standardized mortality rate for head and neck cancer in China decreased more significantly than the global average. Although the overall trend in China showed a decrease, there were sporadic increases, especially among males. In contrast, females exhibited a more consistent decline. The age-period-cohort analysis demonstrated increasing mortality with age, decreasing mortality over successive periods, and fluctuating cohort effects, with a marked decrease for cohorts born after 1930.

CONCLUSION

Overall, the mortality rate for head and neck cancer in China is declining, with age being a significant risk factor for mortality, and earlier-born cohorts facing higher risks. Continuous monitoring is essential to understand the impact of evolving clinical practice guidelines on the mortality of head and neck cancer.

Environmental pollution and cancer

OBJECTIVE

To identify and describe pollutants with carcinogenic potential that contaminate indoor and outdoor air, food and soil.

DATA SOURCE

The descriptors environmental pollutants, occupational cancer, prevention and soil pollutants were used to conduct the research for literature review. Articles published from 2003 to 2024 in the electronic databases Pubmed Medline, Lilacs and Scielo, in Portuguese and English, were included.

SUMMARY OF FINDINGS

There are multiple sources of pollution in the external and internal environments, including motor vehicles, industrial facilities, smoke from tobacco products, agricultural activities, fires and domestic combustion devices. The most important pollutants related to chemical substances include all forms of asbestos, benzene, exhaust gases from gasoline engines, food and water contaminants, such as arsenic and inorganic arsenic compounds, in addition to persistent organic pollutants, such as dioxins. The use of fossil fuels and biomass for domestic heating are also important sources of pollution. The carcinogenic potential of pollutants varies according to the sources of pollution, climate conditions and the region's topography.

CONCLUSIONS

Global environmental pollution is an international public health problem with multiple health effects. Many environmental pollutants are proven to be carcinogenic to adults, while few causes have been scientifically established for children. Pollution is mainly caused by uncontrolled urbanization and industrialization. Preventing environmental exposure to carcinogenic pollutants requires both government regulation and community action and commitment.

A Linkage Between 25-Hydroxyvitamin D and Post-Stroke Cognitive Impairment, as Well as the Duration of Hospitalization After a Stroke

AIMS

A variety of complications can arise following a stroke, with post-stroke cognitive impairment (PSCI) being a prevalent consequence. The objective of the research was to explore the relationship between 25(OH)D levels, PSCI, and the duration of hospitalization.

METHODS

Serum concentrations of 25(OH)D were measured within the first 24 h of hospital admission. Cognitive impairment in stroke patients was assessed using the Mini-Mental State Examination (MMSE). Functional independence was evaluated on the day of discharge using the Barthel Index (BI). Additionally, the duration of hospitalization for each patient was recorded. Data analysis was performed using SPSS statistical software.

RESULTS

An observation revealed that levels of 25(OH)D were comparatively reduced in stroke people who suffered from cognitive impairment as opposed to individuals without such impairment (p = 0.022). Patients with cognitive impairment following a stroke demonstrated reduced BI scores (p < 0.001) and longer durations of hospitalization (p = 0.002) in contrast to patients without cognitive impairment. Upon comparing groups with different concentrations of 25(OH)D, it was observed that individuals with low concentrations had longer hospitalization durations (p = 0.03) and higher NIHSS scores (p = 0.003) than those with high concentrations of 25(OH)D. Furthermore, binary logistic regression analysis indicated that a 25(OH)D level of < 25 nmol/L was a significant risk factor for cognitive impairment following a stroke.

CONCLUSIONS

The study indicated a potential linkage between reduced levels of 25(OH)D and an escalated susceptibility to cognitive impairment following a stroke. Furthermore, individuals with lower concentrations of 25(OH)D generally experienced longer hospital stays.

Momentary predictors of tobacco lapse among African Americans during a quit attempt

BACKGROUND AND AIMS

African American smokers are less likely to successfully quit and experience a greater burden of tobacco-related health outcomes than White individuals. There is a profound need to understand factors that impact tobacco cessation among African Americans who are undergoing a quit attempt. This study aimed to examine the within- and between-person associations of risk factors (motivation, self-efficacy, urge, positive affect, negative affect, smoking expectancies, and cigarette availability) with lapse.

DESIGN AND SETTING

Observational study in the Houston, TX area that used ecological momentary assessment (EMA) to collect data for 10 days following a smoking quit attempt. Multilevel modeling was used to test associations between risk factors and lapse.

PARTICIPANTS

N = 211 African American adults, 51 % female, and ages 18-74.

MEASUREMENTS

EMA was used to assess risk factors (motivation, self-efficacy, urge, positive affect, negative affect, smoking expectancies, and cigarette availability) and lapse.

FINDINGS

At the within-person level, moments characterized by greater urge, smoking expectancies, and cigarette availability were associated with greater risk of lapse in daily life. At the between-person level, those who had lower motivation and self-efficacy and greater urge, smoking expectancies, and cigarette availability were more likely to lapse in daily life.

CONCLUSIONS

The current study addresses important theoretical underpinnings regarding the dynamic nature of predictors of lapse. Although some predictors (urge, smoking expectancies, cigarette availability) did have a significant effect with lapse in expected directions, between person effects may be increasingly important in this population, and additional momentary predictors should be explored in future research.

Identification of EXO1 as a potential biomarker associated with prognosis and tumor immune microenvironment for specific human cancers

Exonuclease 1 (EXO1) is an evolutionarily conserved exonuclease, which have function on maintaining genomic stability. Elevated expression of EXO1 has been reported in certain cancers. However, a comprehensive pan-cancer analysis of EXO1 is still lacking and its role in human cancer development remains poorly understood. This study aims to investigate the genetic alterations and expression perturbations of EXO1 and evaluate its potential clinical relevance in different cancer types. By employing powerful bioinformatics tools and utilizing data sourced from The Cancer Genome Atlas and the Genotype-Tissue Expression datasets, a comprehensive pan-cancer analysis of EXO1 was conducted, including an examination of gene expression, alterations in genetics, DNA methylation patterns, survival outcomes, clinical traits, immune features, and functional enrichment analysis. EXO1 was found to be highly expressed across 20 tumor types, including lung adenocarcinoma, lung squamous cell carcinoma, and breast invasive carcinoma. The expression levels of EXO1 are frequently associated with later clinical stages and unfavorable outcomes. Genetic alterations in EXO1 were predominantly found to be amplified in a pan-cancer context. A total of 131 missense mutations, 24 truncation mutations, 1 in-frame mutation, 6 splice site mutations, and 1 fusion mutation were identified. Interestingly, a significant co-occurrence of alterations in EXO1 with other ten gene alterations were identified. The expression of EXO1 in multiple tumors showed a significant correlation with tumor mutational burden, microsatellite instability, and genes related to immunological checkpoints. In most types of cancer, a strong correlation exists between the expression of EXO1 and the infiltration of CD4+ Th2 cells, memory CD4+ T cells, myeloid-derived suppressor cells, and common lymphoid progenitors. Analysis of 150 genes related to EXO1 demonstrate an enrichment in processes such as cell cycle regulation, DNA damage repair, and relevant signaling pathways, suggesting a possible mechanism through which EXO1 may facilitate tumor development. This study offers a deep insight into the role of EXO1 in different types of human cancers, indicating that EXO1 could act as an important prognostic biomarker and a therapeutic target for certain types of cancer.

Myocardial infarction and short- or long-term risk of a subsequent cancer diagnosis: a Danish Nationwide Cohort Study

BACKGROUND

Growing evidence suggests that myocardial infarction (MI) may be a marker of cancer risk, but many aspects of this relation are poorly understood.

OBJECTIVES

To examine the short- and long-term risk of incident cancer in patients presenting with MI.

METHODS

Using nationwide population-based Danish health registries, we identified all patients with a first-time diagnosis of MI (1995-2021) and followed them for up to 28 years for any subsequent diagnosis of cancer. We computed risks and standardized incidence ratios with 95% CIs as the observed number of cancers relative to the expected number based on national cancer incidence rates by sex, age, and calendar year.

RESULTS

Among 185 065 patients diagnosed with MI, we observed 25 315 subsequent cancers. The risk of any cancer was 2.4% after 1 year of follow-up, increasing to 25.8% after 28 years, taking the competing risks of death into account. During the first year of follow-up, the standardized incidence ratio of any cancer was 1.67 (95% CI, 1.62-1.73). The standardized incidence ratio remained moderately elevated during 2 to 5 years (1.03; 95% CI, 1.01-1.05) and beyond 5 years (1.07; 95% CI, 1.05-1.09). The strongest associations were found for hematological as well as obesity- and smoking-related cancers during the first year of follow-up, whereas primarily, the risk of smoking-related cancers remained elevated throughout the entire follow-up period.

CONCLUSION

MI was associated with subsequent risk of cancer, driven by hematologic, obesity-, and smoking-related cancers in the short term and smoking-related cancers in the long term.

Comparison analysis of the burden and attributable risk factors of early-onset and late-onset colorectal cancer in China from 1990 to 2019

OBJECTIVES

The project intended to analyze the impact of burden and related risk factors of late-onset colorectal cancer (LOCRC) and early-onset colorectal cancer (EOCRC) in China, thus offering essential references for optimizing prevention and control strategies.

METHOD

Global Burden of Disease Study was employed to describe burden changes of EOCRC and LOCRC in China during 1990-2019, containing the numbers of incidence, deaths, prevalence, and disability-adjusted life years (DALYs), and to compare attributable deaths and DALYs risk factors in varying age and sex segments.

RESULTS

The numbers and corresponding crude rates of incidence, deaths, prevalence, and DALYs of EOCRC and LOCRC in China during 1990-2019 demonstrated an upward trend across all age categories, with males being dramatically predominant. Overall, over time, the impact of a low-calcium diet and a low-fiber diet on mortality and DALY rates decreased, while the impact of other risk factors increased. In terms of gender, the risk factors affecting males changed greatly, with smoking, inadequate milk intake, and the low whole-grain diet being the main factors in 2019, while in 1990, the main factors were the low-calcium diet, smoking, and inadequate milk intake.

CONCLUSION

The burden of colorectal cancer in China is concerning. Patients grouped by diagnostic age exhibit different characteristics, indicating the need for high-quality research in the future to achieve personalized medicine tailored to different population characteristics.

Impact of histopathological subtypes on invasive lung adenocarcinoma: from epidemiology to tumour microenvironment to therapeutic strategies

Lung adenocarcinoma is the most prevalent type of lung cancer, with invasive lung adenocarcinoma being the most common subtype. Screening and early treatment of high-risk individuals have improved survival; however, significant differences in prognosis still exist among patients at the same stage, especially in the early stages. Invasive lung adenocarcinoma has different histological morphologies and biological characteristics that can distinguish its prognosis. Notably, several studies have found that the pathological subtypes of invasive lung adenocarcinoma are closely associated with clinical treatment. This review summarised the distribution of various pathological subtypes of invasive lung adenocarcinoma in the population and their relationship with sex, smoking, imaging features, and other histological characteristics. We comprehensively analysed the genetic characteristics and biomarkers of the different pathological subtypes of invasive lung adenocarcinoma. Understanding the interaction between the pathological subtypes of invasive lung adenocarcinoma and the tumour microenvironment helps to reveal new therapeutic targets for lung adenocarcinoma. We also extensively reviewed the prognosis of various pathological subtypes and their effects on selecting surgical methods and adjuvant therapy and explored future treatment strategies.

Risk-benefits assessment of tamoxifen or raloxifene as chemoprevention for risk reduction of breast cancer among BRCA1 and BRCA2 carriers: a meta-analysis

BACKGROUND

Breast cancer is a major global health burden, with hereditary factors such as BRCA1/2 mutations significantly increasing the lifetime risk. This meta-analysis aimed to evaluate the outcomes of selective estrogen receptor modulators (SERMs), tamoxifen, and raloxifene as chemopreventive agents for breast cancer risk reduction in BRCA1/2 mutation carriers.

METHODS

A meta-analysis was conducted according to the PRISMA guidelines. PubMed, Cochrane Library, and MEDLINE databases were searched for relevant studies published between 2000 and 2024. Case-control studies and observational cohort studies examining the use of tamoxifen/raloxifene in BRCA1/2 carriers were included. Data on the incidence and risk ratios of breast cancer were also extracted. Quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was performed using Review Manager (version 5.4.0).

RESULTS

Nine studies (13,676 women) were included. Two studies had low risk, and the remaining seven studies had moderate risk, as assessed by the NOS checklist. Pooled analysis showed tamoxifen/raloxifene decreased breast cancer risk compared to controls (RR 0.80, 95% CI 0.72-0.88, p = 0.04). The risk ratio of breast cancer incidence among BRCA1/2 carriers was reduced after tamoxifen use (RR 1.82, 95% CI 1.48-2.23, p < 0.00001). Subgroup analysis revealed reduced breast cancer risk with SERM use in both BRCA1 (RR 1.51, 95% CI 1.48-1.51) and BRCA2 carriers (RR 1.48, 95% CI 1.40-1.58). The heterogeneity ranged from 51 to 85%, representing high significance and variation in true effect sizes underlying the different included studies. Whereas the heterogeneity among subgroups BRCA1 and BRCA2 was 98%, and the difference was 0%, showing no difference in response to SERM for risk reduction of breast cancer.

CONCLUSION

This meta-analysis provides evidence that tamoxifen and raloxifene significantly reduce the breast cancer risk in women with BRCA1/2 mutations. Chemoprevention efficacy was similar for both BRCA1 and BRCA2 carriers. Further research is needed to validate these findings and to optimize their use in high-risk populations.

AI-generated cancer prevention influencers can target risk groups on social media at low cost

BACKGROUND

This study explores the potential of Artificial Intelligence (AI)-generated social media influencers to disseminate cancer prevention messages. Utilizing a Generative AI (GenAI) application, we created a virtual persona, "Wanda", to promote cancer awareness on Instagram.

METHODS

We created five posts, addressing the five most modifiable risk factors for cancer: tobacco consumption, unhealthy diet, sun exposure, alcohol consumption, and Human Papillomavirus (HPV) infection. To amplify the campaign's reach, posts were boosted using a custom-targeted as well as an automated advertisement algorithm. An overall budget of €100 was equally distributed between the two algorithms. Campaign performance was assessed based on the number of users reached and the age distribution of the audience.

RESULTS

The campaign achieved a total of 9902 recognitions, with a cost-efficiency analysis revealing an average expenditure of €0.013 per reach. The most economical intervention achieved a cost of only €0.006 per reach. In comparing the two advertisement strategies, we observed similar overall reach but noted differences in the age demographics of the audience.

CONCLUSION

Our findings underscore the potential of combining generative AI with strategically targeted advertisement to promote cancer prevention messages effectively, with minimal time and financial investment. We discuss chances presented by GenAI applications in health communication, their implication, and the impact of parasocial relationships on content perception. This study highlights the potential of AI-driven influencers as scalable tools for digital health communication.

Global burden of colorectal cancer attributable to metabolic risks from 1990 to 2021, with projections of mortality to 2035

BACKGROUND

The global burden of colorectal cancer (CRC) attributable to metabolic risk factors is increasing. It is crucial to analyze the global epidemiological patterns of CRC attributable to metabolic risk factors and predict future trends.

METHODS

Detailed data on CRC mortality and disability-adjusted life years (DALYs) attributable to metabolic risk factors were extracted for this study using data from the Global Burden of Diseases (GBD) 2021 study to assess the burden of CRC from 1990 to 2021 by global, regional, national, and sociodemographic index (SDI) regions and quantify the time trend using the estimated annual percentage change (EAPC). Bayesian age-period-cohort (BAPC) models projected the global mortality from 2022 to 2035.

RESULTS

The global number of CRC deaths due to metabolic risk factors increased from 70,916 in 1990 to 172,993 in 2021, a 2.4-fold increase. CRC mortality and DALYs attributable to high body mass index (BMI) and fasting plasma glucose (FPG) increased significantly at the global level from 1990 to 2021. In 2021, the GBD regions with the highest CRC age-standardized mortality rate (ASMR) due to high BMI and high FPG were in Central Europe. The ASMR of CRC attributable to high BMI and high FPG among males is expected to increase from 2022 to 2035.

CONCLUSION

CRC mortality and DALYs attributable to metabolic factors are increasing. Reducing the burden of CRC due to high BMI and FPG levels is critically needed.

The role of imaging in defining cardiovascular risk to help cancer patient management: a scoping review

OBJECTIVE

This scoping review explores the potential role of cancer-staging chest CT scans in assessing cardiovascular (CV) risk in cancer patients. It aims to evaluate: (1) the correlation between non-gated chest CT and the conventional Agatston score from cardiac CT; (2) the association between coronary calcium scores from non-gated chest CT and CV risk in non-oncological patients; (3) the link between coronary calcium assessed by non-gated chest CT and CV events or endothelial damage in cancer patients.

METHODS

Three different searches were performed on PubMed, according to the three steps described above. Both original articles and systematic reviews were included.

RESULTS

Many studies in the literature have found a strong correlation between coronary calcium scores from non-gated chest CTs and the conventional Agatston scores from gated cardiac CTs. Various methodologies, including Agatston scoring, ordinal scoring, and the "extent" and "length" methods, have been successfully adapted for use with non-gated chest CTs. Studies show that non-gated scans, even those using iodinated contrast, can accurately assess coronary calcification and predict CV risk, with correlations as high as r = 0.94 when compared to cardiac CTs. In oncological settings, studies demonstrated a significant link between coronary calcium levels on non-gated chest CTs and higher CV risk, including MACE and overall mortality.

CONCLUSIONS

Radiological assessment of coronary calcium on non-gated CT scans shows potential for improving CV risk prediction.

CRITICAL RELEVANCE STATEMENT

Non-gated chest CT scans can detect endothelial damage in cancer patients, highlighting the need for standardized radiological practices to assess CV risks during routine oncological follow-up, thereby enhancing radiology's role in comprehensive cancer care.

KEY POINTS

Cancer therapies improve outcomes but increase cardiovascular risk, requiring balanced management. Coronary calcification on non-gated CT correlates with Agatston scores, predicting cardiovascular risk. Routinely performed CTs predict cardiovascular risk, optimizing the management of cancer patients.

Cancer prevalence and its determinants in Hungary: Analyzing data from the 2009, 2014, and 2019 European Health Interview Surveys

Background and aim Hungary has the fifth highest cancer incidence rate in the European Union, with an age-standardized rate (ASR) of 336.7 per 100,000 according to GLOBOCAN 2022. Additionally, Hungary holds the highest cancer mortality rate in the EU, with an ASR of 148.1 per 100,000. This study aimed to investigate the sociodemographic, lifestyle, and chronic disease-related factors affecting cancer prevalence in the Hungarian population. Materials and methods Data from the 2009, 2014, and 2019 installments of the European Health Interview Survey conducted in Hungary were pooled, resulting in a representative sample of 16,480 individuals. Weighted multiple logistic regression models were used to analyze the data, with goodness of fit assessed using the Hosmer-Lemeshow test. The best-fitting models were further evaluated using ROC analysis to calculate the Area Under the Curve (AUC) to assess discriminative ability. Results Urban residency was associated with higher cancer odds in 2014 (OR 1.85 [CI: 1.08-3.16]) and the pooled data (OR 1.44 [CI: 1.08-1.9]). Employed individuals had lower odds of cancer (2014: OR 0.34 [CI: 0.16-0.74]; pooled: OR 0.64 [CI: 0.45-0.92]). Among comorbid conditions, peptic ulcer (2009: OR 1.74 [CI: 1.13-2.69]; 2019: OR 3.2 [CI: 1.58-6.47]; pooled: OR 1.83 [CI: 1.31-2.54]) and chronic liver disease (2009: OR 3.52 [CI: 1.73-7.17]; pooled: OR 2.5 [CI: 1.4-4.47]) were significantly associated with higher cancer odds. Reporting bad health was linked to increased cancer risk (2009: OR 2.92 [CI: 1.87-4.58]; 2014: OR 5.52 [CI: 3.23-9.45]; 2019: OR 2.23 [CI: 1.26-3.95]). Conclusion Comorbid conditions such as peptic ulcer and chronic liver disease significantly increase cancer risk in Hungary. Urban residents require targeted preventive measures, and unemployment should be addressed. Early detection through appropriate screening and effective management of comorbid conditions are essential to prevent escalation and reduce overall cancer prevalence.

Identifying invasiveness to aid lung adenocarcinoma diagnosis using deep learning and pathomics

Most classification efforts for primary subtypes of lung adenocarcinoma (LUAD) have not yet been integrated into clinical practice. This study explores the feasibility of combining deep learning and pathomics to identify tumor invasiveness in LUAD patients, highlighting its potential clinical value in assisting junior and intermediate pathologists. We retrospectively analyzed whole slide image (WSI) data from 289 patients with surgically resected ground-glass nodules (GGNs). First, three ResNet deep learning models were used to identify tumor regions. Second, features from the best-performing model were extracted to build pathomics using machine learning classifiers. Third, the accuracy of pathomics in predicting tumor invasiveness was compared with junior and intermediate pathologists' diagnoses. Performance was evaluated using the area under receiver operator characteristic curve (AUC). On the test cohort, ResNet18 achieved the highest AUC (0.956) and sensitivity (0.832) in identifying tumor areas, with an accuracy of 0.904; Random Forest provided high accuracy and AUC values of 0.814 and 0.807 in assessing tumor invasiveness. Pathology assistance improved diagnostic accuracy for junior and intermediate pathologists, with AUC values increasing from 0.547 to 0.759 and 0.656 to 0.769. This study suggests that deep learning and pathomics can enhance diagnostic accuracy, offering valuable support to pathologists.

A comparative analysis of global and Chinese trends in the burden of kidney cancer from 1990 to 2021

Kidney cancer, a prevalent malignant tumor in the urinary system, poses a significant disease burden and remains a crucial public health concern. Utilizing GBD(Global Burden of Disease)2021 data, our study examined the standardized incidence, mortality, prevalence, and DALYs(Disability Adjusted Life Years) rate of renal cancer. We calculated the [1-MIR(Mortality to Incidence Ratio)] value to assess treatment outcomes and survival rates, employed a joinpoint regression model to determine the AAPC(Average Annual Percentage Change), and conducted comparative and longitudinal analyses between China and global trends. The SII(Slope Index of Inequality) and the CI(Concentration Index) were used to assess the DALYs inequality caused by kidney cancer, and the SDI(Socio-demographic Index) was used as the basis for the ranking. Through the joinpoint regression model, we calculated the AAPC and conducted a comprehensive analysis of the disease burden of kidney cancer, evaluating its current status and changing trends. From 1990 to 2021, the age-standardized incidence rate, age-standardized mortality rate, age-standardized prevalence rate, and age-standardized DALYs rate of kidney cancer in China were lower than those the global average. However, the growth rate in China was significantly faster than the global average. The age-standardized incidence rate and prevalence rate of kidney cancer in males showed a greater increase compared to females, both in China and globally. Additionally, the age-standardized rate of kidney cancer in males was notably higher than in females, particularly among middle-aged males. The (1-MIR) of renal cancer increased from 0.36 to 0.62 in China and from 0.49 to 0.58 globally. Overall, the treatment effect of renal cancer has shown some successful outcomes. The SII decreased from 53.47 to 50.19, and the CI decreased from 0.342 to 0.289. The health inequality level of kidney cancer was significant but alleviated. From 1990 to 2021, there was a noticeable increase in the global incidence of kidney cancer. Specifically, the standardized incidence and prevalence of kidney cancer in the Chinese population saw a more rapid rise compared to the global average. Additionally, the disease burden of kidney cancer remained significantly higher in males than in females.

Optimizing the Future: A Game Theory to Tumor Therapeutic Strategies

BACKGROUND

Cancer poses significant economic and societal burdens on countries in the coming decades. During chemotherapy, patients frequently encounter adverse reactions. Recent research has revealed that Chinese medicine plays a crucial role in mitigating the side effects of chemotherapy. Therefore, in this article, we propose that the cancer treatment process can be likened to an unequal game. To refine treatment strategies, we suggest employing the Steinberg model to incorporate Chinese medicine into the chemotherapy regimen for tumor treatment.

RESULTS

We found that when malignant tumors exhibit vigorous proliferation, doctors should administer Chinese medicine in conjunction with chemotherapy drugs, continuously optimizing the therapeutic effect of the Chinese medicine. Upon reaching a specific threshold in the treatment effect of the Chinese medicine, doctors may appropriately augment the dosage of chemotherapy drugs, building upon the initial regimen. Conversely, in cases where the proliferation ability of malignant tumors is weak, the dosage of chemotherapy and the adjuvant therapy with Chinese medicine should be kept in a relatively balanced state. Once the effect of the Chinese medicine attains a particular threshold, the dosage of chemotherapy can be concurrently increased to achieve a superior therapeutic result.

CONCLUSIONS

From a game theory perspective, doctors can devise strategies to minimize drug toxicity and improve tumor treatment outcomes by coordinating the use of chemotherapy drugs with appropriate adjustments to Chinese medicine therapy methods.

Cancer mortality and sectors of employment: a cohort study in Italy

BACKGROUND

Cancer is a multifactorial disease. The large impact of occupational exposure on the burden of cancer continues to be a paramount public health concern that deserves more attention. The study aims to evaluate cancer-specific mortality risk in relation to sectors of employment.

METHODS

We used a cohort from the Rome Longitudinal Study (ROL) and linked it with the National Social Insurance Agency (INPS) database to obtain working histories. We considered the longest duration of employment in a sector as a proxy of exposure, and insurance activities as the reference category. A Cox regression adjusted model was used to examine the associations between cancer-specific causes of death and the sector of employment in men and women. A similar analysis was performed considering the length of employment (≤ 10 years versus ≥ 10 years).

RESULTS

The study population comprised 910,559 (52% of the total population of the cohort after linkage with INPS) 30 + yr employees (53% men and 47% women) followed for a total period of approximately 7 million years. The outcomes confirmed some well-known associations (e.g. lung and pleura in construction, pleura in paper and printing, and lung in wood and leather) and suggested possible high-risk sectors that have not yet been thoroughly investigated. In men we observed an increased mortality risk for stomach cancer in the printing and paper industry (HR = 1.69, 95% CI:1.11-2.57) as well as for stomach and lung cancer in cleaning activities (HR = 1.98, 95% CI:1.13-3.49 and HR = 1.55, 95% CI:1.22-1.98, respectively). Among women, there was an elevated mortality risk in the cleaning industry for all malignant cancers (HR = 1.15, 95% CI:1.03-1.29), liver cancer (HR = 1.94, 95% CI:1.08-3.48) and cancer of the lympho-hematopoietic tissue (HR = 1.65, 95% CI:1.09-2.50).

CONCLUSIONS

The results showed an increased risk of cancer death in some traditional industrial sectors compared to the reference category of insurance activities such as construction and wood and leather products and limited evidence in sectors like cleaning, accommodation and food services and hairdressing. The adopted method proved to be effective in monitoring occupational risks and activating proper prevention initiatives and further insights.

Evolving prognostic paradigms in lung adenocarcinoma with brain metastases: a web-based predictive model enhanced by machine learning

INTRODUCTION

Patients with lung adenocarcinoma (LUAD) who develop brain metastases (BM) face significantly poor prognoses. A well-crafted prognostic model could greatly assist clinicians in patient counseling and in devising tailored therapeutic strategies.

METHODS

The study cohort comprised LUAD patients with BM identified from the surveillance, epidemiology, and end results database between 2000 and 2018. We pinpointed independent prognostic features for overall survival (OS) using Lasso regression analyses. Predictive models were built using Random Forest, XGBoost, Decision Trees, and Artificial Neural Networks, with their performance evaluated via metrics including the area under the receiver operating characteristic curve (AUC), calibration plots, brier score, and decision curve analysis (DCA).

RESULTS

We extracted a total of 9121 eligible patients from the database, identifying eleven clinical parameters that significantly influenced OS prognostication. The XGBoost model exhibited superior discriminative power, achieving AUC values of 0.829 and 0.827 for 1- and 2-year survival, respectively, in the training cohort, and 0.816 and 0.809 in the validation cohort. In comparison to other models, the XGBoost model excelled in both training and validation phases, as demonstrated by substantial differences in AUC, DCA, calibration, and Brier score. This model has been made accessible via a web-based platform.

CONCLUSIONS

This study has developed an XGBoost-based machine learning model with an accompanying web-based application, providing a novel resource for clinicians to support personalized decision-making and enhance treatment outcomes for LUAD patients with BM.

Relationship between parental smoking and adolescent smoking: gender differences and mediation of resilience

BACKGROUND

Though the relationship between parental smoking and adolescent smoking has been established, gender differences, and mediation of resilience in this relationship are poorly understood. This research aims to investigate the prevalence of adolescent smoking, and to understand how consequences may differ for boys and girls, as well as to explore what role resilience played in this relationship.

METHODS

Through the school-based cross-sectional survey, a total of 65,898 adolescents were involved in this study, and information were collected by self-reported questionnaire. Participants' smoking status and their parental smoking status were collected by self-made questionnaire, and resilience was assessed by the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). The multivariate logistic regression was conducted to explore the relationship between parental smoking and adolescent smoking. After that, the path analysis was applied to explore the mediation of resilience in this relationship.

RESULTS

Of all participants, the rate of self-report current smoking and biologically verified smoking was 1.4% and 2.0%, respectively. Both self-reported and biologically verified prevalence of smoking among boys were higher than that in girls. There were gender differences in the impact of parental smoking on adolescent smoking: mother smoking had a negative effect on adolescent smoking, and resilience could mitigate this negative effect. Father smoking had no association with girl smoking, while father smoking was positively associated with boy smoking, and resilience was mediated in this association.

CONCLUSIONS

Our findings suggested smoking prevention in adolescents can be done differently for different genders. Besides, results indicated resilience was important in preventing adolescent smoking. Furthermore, parents quitting smoking can play an important role in preventing adolescent smoking to a certain extent.

Socioeconomic and Geographic Differences in Mammography Trends Following the 2009 USPSTF Policy Update

Importance

In 2024, the US Preventive Services Task Force (USPSTF) reversed a 2009 policy recommending only females aged 50 to 74 years complete a biennial mammogram. Understanding whether females facing heterogeneous breast cancer risks responded to the 2009 guidance may illuminate how they may respond to the latest policy update.

Objective

To evaluate whether the 2009 policy was associated with changes in mammography screening in females no longer recommended to complete a biennial mammogram and whether these changes varied by factors associated with breast cancer risk.

Design, Setting, and Participants

The difference-in-differences design compared biennial mammogram trends in the exposed groups (aged 40-49 and ≥75 years) with trends of the unexposed groups (aged 50-64 and 65-74 years), before and after the 2009 update. Population-based, repeated cross-sectional survey data came from the Behavioral Risk Factor Surveillance System (BRFSS) biennial cancer screening module (2000-2018). The sample was restricted to females between ages 40 and 84 years. Data were analyzed from March 1 to June 30, 2024.

Main Outcomes and Measures

The outcome was a binary variable indicating whether the respondent reported a mammogram in the past 2 years (biennial). After 2009, females aged 40 to 49 and 75 or older years were exposed to the policy update, as a complete biennial mammogram was recommended. Subgroup analyses included race and ethnicity, educational level, household income, smoking history, current binge drinking status, and state of residence.

Results

The sample included 1 594 834 females; 75% reported a biennial mammogram. In those aged 40 to 49 years, the USPSTF update was associated with a 1.1 percentage-point (95% CI, -1.8% to -0.3 percentage points) decrease in the probability of a biennial mammogram, with the largest decreases in the non-Hispanic Black population (-3.0 percentage points; 95% CI, -5.5% to -0.5 percentage points). In the aged 75 years or older group, the USPSTF update was associated with a 4.8 percentage-point decrease (95% CI, -6.3% to -3.5 percentage points) in the probability of a biennial mammogram, with significant heterogeneity by race and ethnicity, binge drinking status, and state residence.

Conclusions and Relevance

In this study, socioeconomic factors were associated with differences in how females responded to the 2009 USPSTF mammography recommendation. Whether the 2024 update considered such differences is unclear. These findings suggest that including risk assessment into future USPSTF policy updates may improve adoption of risk-reducing interventions and shorten the time to diagnosis and treatment for high-risk patients.

Alcohol-related liver and extrahepatic malignancies: burden of disease and socioeconomic disparities in 2019

BACKGROUND

Alcohol is linked to various cancers. While many studies have focused on developed countries, the burden of alcohol-related cancers in developing countries remains underexplored.

METHODS

We analyzed data from the Global Burden of Disease Study (2000-2019) to assess mortality and disability-adjusted life years (DALYs) from alcohol-related cancers in low and low-to-middle sociodemographic index (SDI) countries.

RESULTS

In 2019, there were 494 730 mortality from alcohol-related cancer. Low and low-middle SDI countries contributed over 15% of global mortality of alcohol-related cancer. Among multiple types of cancer, other pharyngeal cancers in these countries accounted for over 30% of global mortality of alcohol-related cancer. Primary liver cancer exhibited the highest mortality ( n  = 16 090) in low and low-middle SDI countries. While deaths and DALYs rates from alcohol-related cancers decreased globally between 2000 and 2019, the related burden increased in low and low-middle SDI countries with a rise in all types of alcohol-related cancers, except for primary liver cancer. The most rapidly growing mortality rates in low SDI were from other pharyngeal cancers (+2.25%), whereas in low-middle SDI countries, colorectal cancer evidenced the highest increase (+2.76%).

CONCLUSION

The burden from alcohol-related cancer has risen in countries with low and low-to-middle SDI, especially other pharyngeal cancers and colorectal cancer. Policymakers should focus on improving alcohol-related policies as well as screening availability to tackle the associated burden of cancer in resource-constrained countries. However, the difficulty in isolating the impact of alcohol due to limited data on other confounders necessitates caution in interpreting these findings.

Global, regional, and national burden of male breast cancer in 204 countries and territories: a systematic analysis from the global burden of disease study, 1990-2021

Background

Male breast cancer (MBC) is a rare malignancy that has been under-investigated, with limited global epidemiological research dedicated to it. A comprehensive estimate of the global, regional, and national burden of MBC is valuable for policy planning. This study aims to evaluate the burden of MBC across 204 countries and territories.

Methods

MBC data were collected from the 2021 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates spanning from 1990 to 2021. The global incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) attributed to MBC, as well as corresponding age-standardized rates, were calculated. Temporal trends, projections of incidence and mortality to 2050, lifetime risk, and risk factors of MBC were also estimated according to regions and countries.

Findings

In 2021, there were 38,827 (95% uncertainty interval [UI], 24,650-47,846) new cases, 320,459 (95% UI, 220,533-384,317) prevalent cases, 13,274 (95% UI, 9074-16,240) deaths, and 380,917 (95% UI, 252,922-476,417) DALYs attributed to MBC worldwide, with the highest disease burden observed in the Eastern Sub-Saharan Africa region. From 1990 to 2021, the age-standardized incidence and mortality rates of MBC significantly increased, but they are projected to decrease over the next 30 years. High-middle Socio-demographic Index (SDI) quintile had the highest lifetime risk of developing MBC, while the low SDI quintile had the highest lifetime risk of dying from MBC. Dietary risk and alcohol use were identified as important risk factors for MBC deaths and DALYs globally.

Interpretation

The global burden of MBC significantly increased from 1990 to 2021, with notable geographic disparities. Efforts aimed at MBC prevention and control strategies should take into account the inequities in its global distribution.

Funding

This study was supported by the National Natural Science Foundation of China (grant numbers 82372996 and 82202913) and the Chongqing Natural Science Foundation (grant number CSTB2023NSCQ-MSX0480).

Chitosan-based dihydromyricetin composite hydrogel demonstrating sustained release and exceptional antibacterial activity

Plant-derived antibacterial agents are increasingly pivotal in mitigating the escalating threat posed by pathogenic microorganisms. Dihydromyricetin (DMY), a plant bioactive compound prevalent in Ampelopsis grossedentata, exhibits remarkable antibacterial properties. However, its poor solubility in water significantly hinders its application in antibacterial therapies, necessitating the exploration of suitable carriers for the loading and sustained release of DMY. In this study, a chitosan-based hydrogel was rapidly synthesized at 25 °C using carboxymethyl chitosan and sodium alginate as precursors, and then utilized for the encapsulation of DMY. The as-prepared hydrogel was characterized using scanning electron microscopy, Fourier-transform infrared spectroscopy, and thermogravimetric analysis, indicating its favorable swelling properties, injectability, transparency, and self-healing capabilities. Antibacterial assays demonstrated that both surface and internal of the hydrogel exhibited over 99 % inhibition against both Pseudomonas aeruginosa and Staphylococcus aureus when the DMY loading concentration reached 0.4 mg/mL. Furthermore, drug release studies demonstrated that the hydrogel effectively sustained the release of DMY for up to 130 h, irrespective of the acidic or alkaline aqueous solutions, as well as in phosphate-buffered saline. These findings provide novel insights and references for the synergistic antibacterial application of plant-derived agents in conjunction with hydrogels.

A chance for countries to support Ireland's world-leading cancer warning labels for alcohol containers

Ireland has regulated for all packaged alcohol products to include a health warning that states that 'there is a link between alcohol and fatal cancers'. This warning is being opposed in the World Trade Organization by 12 member states who are raising that the warning is an unnecessary barrier to trade. The World Health Organization is supporting Ireland. Countries should not oppose Ireland's warning which is defensible from legal and public health perspectives.

Cancer situation in China: an analysis based on the global epidemiological data released in 2024

BACKGROUND

Cancer remains a major cause of mortality and a significant economic burden in China. Exploring the disparities in cancer patterns and control strategies between China and developed countries may offer valuable insights for policy formulation and enhance cancer management efforts. This study examined the incidence, mortality, and disability-adjusted life year (DALY) burden of cancer in China, and compared these metrics with those observed in the United States (US) and the United Kingdom (UK).

METHODS

Data on cancer incidence, mortality, and DALYs for China, the US, and the UK were sourced from the GLOBOCAN 2022 online database and the Global Burden of Disease 2021 study (GBD 2021). We utilized Joinpoint regression models to analyze trends in cancer incidence and mortality across these countries, calculating annual percent changes (APCs) and determining the optimal joinpoints.

RESULTS

In 2022, China recorded around 4,824,703 new cancer cases and 2,574,176 cancer-related deaths, contributing to 71,037,170 DALYs. China exhibited a lower cancer incidence rate compared to the US and the UK. Although cancer-related mortality in China is slightly lower than that in the UK, it is significantly higher than that in the US. Additionally, China experienced significantly higher DALY rates compared to both the US and UK. The cancer landscape in China was also undergoing significant changes, with a rapid rise in the incidence and burden of lung, colorectal, breast, cervical, and prostate cancers. Meanwhile, the incidence and burden of stomach cancer continued to decline. Although the incidence of liver and esophageal cancers was decreasing, the burden of liver cancer was increasing, while the burden of esophageal cancer remained largely unchanged.

CONCLUSIONS

The cancer profile of China is shifting from that of a developing country to one more typical of a developed country. The ongoing population aging and the rise in unhealthy lifestyles are expected to further escalate the cancer burden in China. Consequently, it is crucial for Chinese authorities to revise the national cancer control program, drawing on successful strategies from developed countries, while also accounting for the regional diversity in cancer types across China.

The Association Between Physical Activity and Uterine Leiomyoma and Its Symptoms: A Systematic Review and Meta-Analysis

Background and Aims

Although many studies have focused on the impact of physical activity on hormone-mediated tumors, its effect on uterine leiomyomas (UL) remains unclear. This systematic review synthesizes the scientific evidence on the role of physical activity in the occurrence and symptomatology of UL while putting forward a research agenda.

Methods

The PubMed, Scopus, Web of Science, SciELO, and Cochrane Library databases were searched for studies published up to January 10, 2025. The Newcastle‒Ottawa Scale was used to assess study quality, and the GRADE tool was used to determine evidence certainty. Dear-Simonian and Laird random effects models were used to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) of the association between physical activity and UL. The PRISMA guidelines were followed.

Results

Fifteen studies were included (three cross-sectional, 6 case-control, and 6 cohort studies), of which 11 were considered in the meta-analysis. The difference between women who did and did not regularly practice physical activity (OR = 0.93; 95% CI: 0.82, 1.05; I 2 = 77.6%, n = 8 studies) in the likelihood of having UL did not meet conventional levels of statistical significance. Moreover, those women who engaged in more intense physical activity were less likely to have UL (OR = 0.86; 95% CI: 0.75, 0.99; I 2 = 80.5%, n = 5 studies) than those who engaged in less intense physical activity.

Conclusion

Increased physical activity is associated with a slight decrease in the risk of UL and may provide relief from associated symptoms. Since current evidence is still limited to supporting specific physical activity recommendations, a research agenda is proposed for future studies on this subject.

PROSPERO Registration

CRD42021247505.

Neighborhood socioeconomic disparities in cancer incidence following a hypothetical intervention to increase residential greenspace cover in the UK Biobank cohort

BACKGROUND

Higher greenspace exposure has been associated with lower risk of certain cancers. However, few studies have evaluated potential benefits of increasing population-level exposure to greenspace on cancer disparities. We estimated the impact of a hypothetical intervention to increase residential greenspace cover on neighborhood socioeconomic disparities in total, breast, colorectal, lung, and prostate cancer incidence.

METHODS

Our study included 411,787 cancer-free UK Biobank participants. Percentage of greenspace around baseline residential addresses (300m, 1000m distance buffers) was derived by combining domestic gardens and greenspace cover from the Generalized Land Use Database. We categorized neighborhood socioeconomic deprivation using the Index of Multiple Deprivation (2010). We estimated hazard ratios (HR) and 95% confidence intervals (CI) of each cancer associated with greenspace, adjusting for sociodemographic and lifestyle factors. We additionally adjusted for air pollution in supplementary analyses as we a-priori hypothesized that it was on the causal pathway between greenspace and cancer. Further, we used parametric g-computation to calculate the standardized 10-year risk of each cancer, comparing the least to most socioeconomically disadvantaged participants, both without any hypothetical greenspace intervention and under a hypothetical intervention to increase residential greenspace cover to a favorable threshold (75th percentile amongst the least socioeconomically deprived participants).

RESULTS

We documented 40,519 incident cases of cancer over 4,210,008 person-years follow-up. An interquartile range increase in greenspace cover within 300m was associated with lower incidence of total (HR 0.98; 95% CI 0.97, 1.00) and lung (HR 0.96; 95% CI 0.92, 0.99) cancer, and was suggestively associated with lower prostate and breast cancer incidence, but not colorectal cancer. Additional adjustment for fine particulate matter air pollution (PM2.5) weakened lung cancer associations but strengthened breast and prostate cancer associations (e.g., greenspace 1000m breast cancer HR 0.94; 95% CI 0.89 0.99; 1000m prostate cancer HR 0.91; 95% CI 0.86, 0.95). The hypothetical intervention to increase greenspace (300m) resulted in 1.3 fewer total cancer cases per 1000 (95% CI 1.0, 1.6) in the most compared to least deprived group, a 23% reduction in the socioeconomic disparity gap.

DISCUSSION

Higher residential greenspace cover was associated with lower total and lung cancer incidence, and suggestively associated with lower breast and prostate cancer incidence. Policies to increase residential greenspace cover may reduce the risk of certain cancers, particularly among socioeconomically disadvantaged groups.

Is there a link between per capita alcohol consumption and cancer mortality?

INTRODUCTION

A growing body of evidence has established alcohol consumption as a causative factor in an increasing array of cancer types, thereby positioning it as a leading global risk factor for cancer. Surprisingly, there is a scarcity of studies examining the extent to which shifts in population drinking affect cancer mortality, despite the substantial public health implications. This paper aims to: (i) estimate the impact of changes in per capita alcohol consumption on both overall cancer mortality rates and specific types of alcohol-related cancer; and (ii) assess whether the association between cancer and population alcohol consumption is influenced by a country's drinking patterns.

METHODS

We used time-series data for 19 high-income countries spanning the period 1960-2018. Cigarette sales and GDP per capita were included as control variables. The data were analysed using first-difference modelling. The World Health Organization drinking patterns score was used to evaluate a country's drinking pattern.

RESULTS

Our findings revealed that a 1 L per capita increase in alcohol consumption was associated with a 0.9% rise in total cancer mortality among women and a 1.1% increase among men. Notably, among men, the association was more pronounced for cancers with strong evidence of alcohol's effect and for prostate cancer. For women, the alcohol effect was statistically significant for breast cancer. Generally, the estimated alcohol effects were elevated in the country group with more harmful drinking patterns.

DISCUSSION AND CONCLUSIONS

Our results indicate that lowering per capita alcohol consumption is likely to reduce cancer mortality.

The Explo'Santé mixed methods protocol: an interventional research school health promotion project in France

BACKGROUND

According to WHO, "noncommunicable diseases (NCDs) kill 41 million people" annually, as the primary cause of death globally. WHO's Global Action Plan for the prevention and control of NCDs 2013-2020 (extended) tackles this issue and its implications regarding inequalities between countries and populations. Based on combined behavioural, environmental and policy approaches, health promotion aims to reduce health inequities and address health determinants through 3 strategies: education, prevention and protection. It is a well-known fact that long-term efficiency in health promotion, that is to say the promotion of health and well-being, involves interventions and programmes which target / involve children [1]. As a focal point in communities and a key environment for children, school is an important setting to implement health promotion programmes, especially integrated approaches and interventions targeting Life Skills (LS). Indeed, LS contribute to health and well-being, particularly for pupils. This article presents the research protocol of a French integrated school-based health promotion interventional research programme which intends to support the health promoting schools (HPS) approach in France: Explo'Santé. It results from a partnership between the University of Lyon and the French League against Cancer.

METHODS

Explo'Santé is an observational study based on a mixed methods research design, which aims to evaluate the effects of a health promotion programme, to elicit its implementation process and identify contextual factors. This 3-year, complex programme targets primary school pupils aged 8 to 10. It incorporates health education sessions, to develop pupils' LS and health literacy (HL), and to promote healthy environments. Teachers and French League prevention officers are trained to support skill development and programme sustainability. Data collection includes quantitative data via questionnaires, to assess programme impact on approximately 700 pupils, as well as 36 teachers, and 6 prevention officers, as well as qualitative data collected via focus groups with pupils, and interviews with teachers, parents, prevention officers, and school heads, to understand the barriers and promoting factors to the implementation of the programme, the differences in process and effects in different contexts, and its potential for sustainability.

DISCUSSION

Explo'Santé was designed to contribute to school-based health promotion strategies, by including key players, promoting partnerships, targeting multiple levels of impact and effect, and to ensure every step is research-based and informed. Finally, this study aims to identify the elements which would enable Explo'Santé to become a model in France and internationally.

Spatiotemporal Correlation Analysis for the Incidence of Esophageal and Gastric Cancer From 2010 to 2019: Ecological Study

Background

Esophageal and gastric cancer were among the top 10 most common cancers worldwide. In addition, sex-specific differences were observed in the incidence. Due to their anatomic proximity, the 2 cancers have both different but also shared risk factors and epidemiological features. Exploring the potential correlated incidence pattern of them, holds significant importance in providing clues in the etiology and preventive strategies.

Objective

This study aims to explore the spatiotemporal correlation between the incidence patterns of esophageal and gastric cancer in 204 countries and territories from 2010 to 2019 so that prevention and control strategies can be more effective.

Methods

The data of esophageal and gastric cancer were sourced from the Global Burden of Disease (GBD). Spatial autocorrelation analysis using Moran I in ArcGIS 10.8 (Esri) was performed to determine spatial clustering of each cancer incidence. We classified different risk areas based on the risk ratio (RR) of the 2 cancers in various countries to the global, and the correlation between their RR was evaluated using Pearson correlation coefficient. Temporal trends were quantified by calculating the average annual percent change (AAPC), and the correlation between the temporal trends of both cancers was evaluated using Pearson correlation coefficients.

Results

In 2019, among 204 countries and territories, the age-standardized incidence rates (ASIR) of esophageal cancer ranged from 0.91 (95% CI 0.65-1.58) to 24.53 (95% CI 18.74-32.51), and the ASIR of gastric cancer ranged from 3.28 (95% CI 2.67-3.91) to 43.70 (95% CI 34.29-55.10). Malawi was identified as the highest risk for esophageal cancer (male RR=3.27; female RR=5.19) and low risk for gastric cancer (male RR=0.21; female RR=0.23) in both sexes. Spatial autocorrelation analysis revealed significant spatial clustering of the incidence for both cancers (Moran I>0.20 and P<.001). A positive correlation between the risk of esophageal and gastric cancer was observed in males (r=0.25, P<.001). The ASIR of both cancers showed a decreasing trend globally. The ASIR for esophageal and gastric cancer showed an AAPC of -1.43 (95% CI -1.58 to -1.27) and -1.76 (95% CI -2.08 to -1.43) in males, and -1.93 (95% CI -2.11 to -1.75) and -1.79 (95% CI -2.13 to -1.46) in females. In addition, a positive correlation between the temporal trends in ASIR for both cancers was observed at the global level across sexes (male r=0.98; female r=0.98).

Conclusions

Our study shows that there was a significant spatial clustering of the incidence for esophageal and gastric cancer and a positive correlation between the risk of both cancers across countries was observed in males. In addition, a codescending incidence trend between both cancers was observed at the global level.

Epidemiological status, development trends, and risk factors of disability-adjusted life years due to diabetic kidney disease: A systematic analysis of Global Burden of Disease Study 2021

BACKGROUND

Approximately 40% of individuals with diabetes worldwide are at risk of developing diabetic kidney disease (DKD), which is not only the leading cause of kidney failure, but also significantly increases the risk of cardiovascular disease, causing significant societal health and financial burdens. This study aimed to describe the burden of DKD and explore its cross-country epidemiological status, predict development trends, and assess its risk factors and sociodemographic transitions.

METHODS

Based on the Global Burden of Diseases (GBD) Study 2021, data on DKD due to type 1 diabetes (DKD-T1DM) and type 2 diabetes (DKD-T2DM) were analyzed by sex, age, year, and location. Numbers and age-standardized rates were used to compare the disease burden between DKD-T1DM and DKD-T2DM among locations. Decomposition analysis was used to assess the potential drivers. Locally weighted scatter plot smoothing and Frontier analysis were used to estimate sociodemographic transitions of DKD disability-adjusted life years (DALYs).

RESULTS

The DALYs due to DKD increased markedly from 1990 to 2021, with a 74.0% (from 2,228,000 to 3,876,000) and 173.6% (from 4,123,000 to 11,279,000) increase for DKD-T1DM and DKD-T2DM, respectively. In 2030, the estimated DALYs for DKD-T1DM surpassed 4.4 million, with that of DKD-T2DM exceeding 14.6 million. Notably, middle-sociodemographic index (SDI) quintile was responsible for the most significant DALYs. Decomposition analysis revealed that population growth and aging were major drivers for the increased DKD DALYs in most GBD regions. Interestingly, the most pronounced effect of positive DALYs change from 1990 to 2021 was presented in high-SDI quintile, while in low-SDI quintile, DALYs for DKD-T1DM and DKD-T2DM presented a decreasing trend over the past years. Frontiers analysis revealed that there was a negative association between SDI quintiles and age-standardized DALY rates (ASDRs) in DKD-T1DM and DKD-T2DM. Countries with middle-SDI shouldered disproportionately high DKD burden. Kidney dysfunction (nearly 100% for DKD-T1DM and DKD-T2DM), high fasting plasma glucose (70.8% for DKD-T1DM and 87.4% for DKD-T2DM), and non-optimal temperatures (low and high, 5.0% for DKD-T1DM and 5.1% for DKD-T2DM) were common risk factors for age-standardized DALYs in T1DM-DKD and T2DM-DKD. There were other specific risk factors for DKD-T2DM such as high body mass index (38.2%), high systolic blood pressure (10.2%), dietary risks (17.8%), low physical activity (6.2%), lead exposure (1.2%), and other environmental risks.

CONCLUSIONS

DKD markedly increased and varied significantly across regions, contributing to a substantial disease burden, especially in middle-SDI countries. The rise in DKD is primarily driven by population growth, aging, and key risk factors such as high fasting plasma glucose and kidney dysfunction, with projections suggesting continued escalation of the burden by 2030.

Global, regional and national burdens of occupational injuries, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

OBJECTIVES

Occupational injuries pose a significant challenge to global health and development. This study aimed to quantify the international and regional burdens of occupational injuries from 1990 to 2019, stratified by specific causes.

METHODS

We analysed global trends in deaths, disability-adjusted life years (DALYs), age-standardised mortality rates (ASMR) and age-standardised DALY rates (ASDR) related to occupational injuries. Specific injuries, including animal contact, drowning, mechanical forces, falls, fire, heat, hot substances, foreign bodies, poisoning and road injuries, were evaluated. Age-stratified and regional analyses were also performed.

RESULTS

Globally, the number of deaths, DALYs, ASMR and ASDR related to occupational injuries declined from 1990 to 2019. The middle Socio-demographic Index (SDI) region exhibited the highest burden, whereas the high SDI region showed the least burden. China and India had the highest occupational injury-related death rates in 2019. Males, particularly those aged 25-44 years, were found to be more vulnerable. Road injuries were the leading cause of death in all age groups. Compared with 1990, mortality numbers and rates decreased significantly by 2019, with the highest burdens experienced in East Asia, South Asia and Southeast Asia.

CONCLUSION

The global decline in occupational injuries is promising; however, certain regions and demographics remain disproportionately affected. Targeted interventions in high-burden areas are crucial to further reduce the impact of occupational injuries.

A Qualitative Study to Understand the Barriers and Facilitators in Smoking Cessation Practices Among Oncology Health Care Practitioners in One Health System

INTRODUCTION

Despite the benefits of quitting smoking for those who have cancer, including improved health outcomes and reduced therapeutic toxicities, it is unclear how many people are supported in quit attempts during this time. Variations in the availability and provision of smoking cessation (SC) services are reported, with little understanding of the challenges and solutions. This codesigned study aimed to understand the perspectives of health care professionals (HCPs) working in oncology settings to engage in SC practices and identify recommendations for developing a SC pathway.

AIMS AND METHODS

This was a qualitative study. Eighteen HCPs participated in semi-structured interviews from July 2021 to May 2022. We used thematic analysis approaches to code data and present four themes and SC strategies at micro, meso, and organizational levels.

RESULTS

Four themes are reported specifically: (1) timing and knowledge, (2) building a relationship, (3) frequent asking with infrequent action, and (4) removing the barriers and tailoring the system. While HCPs discuss SC, there are variations in documentation and when conversations occur. Primarily, HCPs value the time to build therapeutic relationships with patients and thus may limit SC discussions in preference to treatment in clinical interactions. The role of structural barriers, including prescriptive authority for nurses, hinders active SC processes, as it is the lack of continuity and embedding of services supported by a clinical champion for SC.

CONCLUSIONS

The study suggests reevaluating the status quo in SC service, highlighting service gaps, and suggesting opportunities at organizational levels to reduce structural barriers.

IMPLICATIONS

Variations in SC services exist in designated cancer centers. The data from this study can be used to inform a real-time health systems approach for SC services in oncology settings. Developing tailored SC services and interventions that are patient-centered and informed by their experiences is required. The data in this study suggest developing specialist education and training to upskill HCPs for equitable engagement if we are to meet EU and Cancer Moonshot goals for cancer reduction.

Motivations and perceptions for physical activity in women living with metastatic breast cancer: a qualitative interview study

BACKGROUND

The beneficial role of physical activity for people living with cancer is well established. However, the importance of physical activity to women living with metastatic breast cancer is not known. As motivations and perceptions around physical activity influence behavioural uptake, a qualitative study was undertaken to explore the motivations and perceptions towards physical activity of this group.

METHODS

Women living with metastatic breast cancer were recruited through a metropolitan cancer centre in Australia to participate in semi-structured interviews about their physical activity. Open-ended questions explored health-specific factors, goals, barriers, enablers, and interests. Interviews were recorded, transcribed and thematically analysed.

RESULTS

Twenty-three women participated; median age was 60 years (IQR: 20) and median time since metastatic diagnosis was 3.3 years (IQR: 3.0). Twelve women were engaged with physical activity, seven reported intentions to be active but found it challenging, and four reported nominal interest in physical activity. Four categories, covering nine themes, were identified: (i) predispositions towards physical activity, incorporating themes on enjoyment and energy, and positivity and mental resilience; (ii) health-related motivations behind physical activity, incorporating themes on physical and mental health benefits; (iii) social motivations behind physical activity, incorporating themes on enjoying exercise with others, role models and social support, and others' negative perceptions of metastatic breast cancer; and (iv) connections between physical activity and metastatic breast cancer, incorporating themes on prognosis uncertainty, and reframing limiting perceptions.

CONCLUSIONS

Participants described a wide-ranging spectrum of experiences and perceptions toward physical activity. Whilst most women perceived improved physical and mental well-being from being physically active, some women were not engaged in being physically active. Behaviour change strategies that target both their attitudes and those around them may address this gap.

Harnessing the tumor microenvironment: targeted cancer therapies through modulation of epithelial-mesenchymal transition

The tumor microenvironment (TME) is integral to cancer progression, impacting metastasis and treatment response. It consists of diverse cell types, extracellular matrix components, and signaling molecules that interact to promote tumor growth and therapeutic resistance. Elucidating the intricate interactions between cancer cells and the TME is crucial in understanding cancer progression and therapeutic challenges. A critical process induced by TME signaling is the epithelial-mesenchymal transition (EMT), wherein epithelial cells acquire mesenchymal traits, which enhance their motility and invasiveness and promote metastasis and cancer progression. By targeting various components of the TME, novel investigational strategies aim to disrupt the TME's contribution to the EMT, thereby improving treatment efficacy, addressing therapeutic resistance, and offering a nuanced approach to cancer therapy. This review scrutinizes the key players in the TME and the TME's contribution to the EMT, emphasizing avenues to therapeutically disrupt the interactions between the various TME components. Moreover, the article discusses the TME's implications for resistance mechanisms and highlights the current therapeutic strategies toward TME modulation along with potential caveats.

The association between dietary creatine intake and cancer in U.S. adults: insights from NHANES 2007-2018

Background

Creatine has anti-inflammatory, antioxidant, and immunomodulatory effects. However, its impact on tumors remains uncertain.

Methods

This study used data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 to investigate the relationship between dietary creatine intake and cancer in American adults. A total of 25,879 participants aged 20 years and older were included, and their medical information, dietary creatine intake, and covariates were collected. Multiple logistic regression models were used to assess the relationships between age, dietary creatine intake, and cancer risk. Restricted cubic spline (RCS) analysis explored the nonlinear relationships between dietary creatine intake, age, and cancer prevalence.

Results

RCS analysis revealed a linear, negative association between dietary creatine intake and cancer risk. For each standard deviation (SD) increase in dietary creatine intake, cancer risk decreased by 5% (adjusted odds ratio (OR) = 0.95, 95% CI: 0.91-0.99, p = 0.025). This negative association was strongest among males (adjusted OR = 0.93, 95% CI: 0.88-0.99, p = 0.021) and overweight participants (adjusted OR = 0.92, 95% CI: 0.84-0.99, p = 0.044). Interaction results indicated specific age group effects. Further analysis showed that higher dietary creatine intake was significantly inversely associated with cancer risk among older adults (adjusted OR = 0.86, 95% CI: 0.77-0.97, p = 0.014). RCS analysis revealed a linear, positive correlation between age and cancer risk. For each SD increase in age, cancer risk increased by 3.27 times (adjusted OR = 3.27, 95% CI: 3.07-3.48, p < 0.001).

Conclusion

These findings suggest that higher dietary creatine intake may reduce cancer risk in a nationally representative adult population. Further prospective studies are needed to clarify the relationship between dietary creatine intake and cancer risk.

Association between physical multimorbidity in middle adulthood and mortality: findings from two large cohort studies in Japan

BACKGROUND

While previous literature suggests that multimorbidity is linked to a higher risk of mortality, evidence is scarce among individuals in middle adulthood. We aimed to examine the association between physical multimorbidity and all-cause mortality among individuals aged 40-64 years at baseline in Japan.

METHODS

Data were obtained from two cohort studies, the Japan Public Health Center-based Prospective Study (JPHC) and the Japan Epidemiology Collaboration on Occupational Health Study (J-ECOH). The study participants were 144,774 individuals aged 40-64 years at baseline who were followed up for a maximum of 29 and 10 years in the JPHC and J-ECOH, respectively. Multimorbidity was defined as the presence of ≥ 2 of 10 morbidities or conditions based on self-reported information. A Cox proportional hazards model was used to examine the association in relation to all-cause mortality. We calculated pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) using a random-effects meta-analysis model. Cause-specific analysis was performed using the JPHC dataset, which provided a sufficient number of events for mortality due to physical disorders, mental disorders/suicide, and unintentional injuries.

RESULTS

During a follow-up of 2,304,375 person-years in the JPHC and 311,637 person-years in the J-ECOH, 23,611 and 275 deaths were recorded, respectively. Participants with vs. without physical multimorbidity at baseline were more likely to die prematurely in both cohorts with a pooled HR of 1.61 (95%CI = 1.29-2.01). Cause-specific analyses among the JPHC participants revealed that physical multimorbidity at baseline was linked with mortality due to physical disorders, mortality due to mental disorders/suicide, and mortality due to unintentional injuries.

CONCLUSIONS

Physical multimorbidity in middle adulthood is associated with an increased risk of all-cause mortality in Japan.

Advancing environmental epidemiologic methods to confront the cancer burden

Even though many environmental carcinogens have been identified, studying their effects on specific cancers has been challenging in nonoccupational settings, where exposures may be chronic but at lower levels. Although exposure measurement methods have improved considerably, along with key opportunities to integrate multi-omic platforms, there remain challenges that need to be considered, particularly around the design of studies. Cancer studies typically exclude individuals with prior cancers and start recruitment in midlife. This translates into a failure to capture individuals who may have been most susceptible because of both germline susceptibility and higher early-life exposures that lead to premature mortality from cancer and/or other environmentally caused diseases like lung diseases. Using the example of breast cancer, we demonstrate how integration of susceptibility, both for cancer risk and for exposure windows, may provide a more complete picture regarding the harm of many different environmental exposures. Choice of study design is critical to examining the effects of environmental exposures, and it will not be enough to just rely on the availability of existing cohorts and samples within these cohorts. In contrast, new, diverse, early-onset case-control studies may provide many benefits to understanding the impact of environmental exposures on cancer risk and mortality. This article is part of a Special Collection on Environmental Epidemiology.

Suboptimal dietary knowledge predicts lower diet quality for cancer prevention among university students in Beirut

University students are at a pivotal stage of shaping cancer risk factors. Little is known about their dietary behavior in Lebanon, a country heavily burdened by cancer. This cross-sectional study assessed the dietary knowledge of and adherence to cancer prevention guidelines among university students in Beirut, Lebanon. We hypothesized that students would exhibit low knowledge, poor diet quality, and that knowledge predicted diet quality. Dietary knowledge was explored using a dedicated questionnaire, with scores above the 60th percentile considered as Knowledgeable (Kn+), and those below as less knowledgeable (Kn-). Dietary adherence to cancer prevention guidelines and the predictors of the Alternative Healthy Eating Index (AHEI)- a measure of diet quality calculated using the Modified Mediterranean Prime Screen, were also examined. The sample included 300 participants (55% females, mean age: 20 years). The mean knowledge score was 49.5%. Over 50% of students were aware of the association between red and processed meat, sodium, fruits and vegetables, obesity, and cancer. Kn+ group had a higher intake of vegetables and a lower intake of meats and sweetened beverages. Increased knowledge (B = 0.78, 95%CI: 0.18,1.37) and high physical activity (B = 4.62, 95%CI: 1.66,7.59) were associated with elevated AHEI scores. A significant positive interaction was observed between knowledge and enrollment in a health-related major. University students' dietary knowledge of and adherence to cancer prevention guidelines are suboptimal. Although higher knowledge predicts high-quality diets, the association was weak. Further studies should investigate the food systems influencing university students' dietary intake of university students in Lebanon and identify effective interventions to enhance health behavior.

Evolving trends in lung cancer risk factors in the ten most populous countries: an analysis of data from the 2019 Global Burden of Disease Study

Background

Amid shifting tobacco policies and escalating air pollution levels, Lung Cancer (LC) risk factors have changed notably. Continuous assessment of these risk factors is necessary. This study compares trends in tobacco, air pollution, and asbestos-associated Age-Standardized Mortality Rates (ASMR) from Trachea, Bronchus, and Lung (TBL) Cancer across the top ten most populated countries (2023 censuses) and globally.

Methods

We extracted overall and risk-factor-associated TBL cancer ASMR of the ten most populated countries for 1990-2019 from the Global Burden of Disease (GBD) database using the dedicated results tool (http://ghdx.healthdata.org/gbd-results-tool). GBD mapped the mortality data related to ICD codes (C33-C34, D02.1-D02.2, D38.1, 162-162.9, 231.1, 231.2, 231.8, 235.7 from ICD10 and B101 from ICD9). Tobacco, occupational exposure to asbestos and air pollution (ambient particulate matter and household air pollution) associated TBL cancer mortality data were extracted to evaluate the trends based on risk factors. We calculated relative changes in ASMRs between 1990 and 2019 for each sex in each country for each risk factor. Joinpoint regression analysis was performed to calculate the Estimated Annual Percentage Change (EAPC) and its corresponding 95% confidence interval (CI) for each line segment, allowing for trend assessment.

Findings

Globally, TBL Cancer mortality has decreased by 8%, with a decrease for males but an increase for females. Globally, both tobacco and air pollution-associated TBL cancer ASMR have decreased. While tobacco-associated ASMR has increased in China and Indonesia, air pollution-associated ASMR has also increased in China, India, Pakistan, and Nigeria. On stratification, while PM-associated mortality increased by 25% globally, household-associated TBL cancer ASMR decreased by 62%. China had the highest PM-associated TBL Cancer in 2019 (8.8/100,000), twice higher than the global average. Despite a decline in asbestos-associated TBL cancer ASMR from 8.91/100,000 to 6.0/100,000, the rate in the United States remained twice higher than the global average for the entire study period.

Interpretation

Tobacco-associated TBL cancer mortality is declining but still predominant. Ambient particulate matter-associated TBL cancer mortality is rising, requiring policy and awareness efforts. Expanding access to preventive services and addressing underlying risk factors are essential steps required toward reducing lung cancer mortality at the global level.

Funding

This study did not receive any funding support.

Bladder Cancer in Lebanon: An Updated Epidemiological Comparison with Global Regions and a Comprehensive Review of Risk Factors

ObjectivesThis study aims to analyze urinary bladder cancer (UBC) incidence rates in Lebanon over a 12-year period (2005-2016) and compare them with rates in other countries. It also discusses UBC risk factors in Lebanon.IntroductionLebanon has one of the highest estimated age-standardized incidence rates (ASIRw) of UBC worldwide.MethodsData on UBC were obtained from the Lebanese national cancer registry for the years 2005-2016. The study calculated age-standardized incidence rates (ASIRw) and age-specific rates per 100 000 population. It also estimated the population attributable fractions of smoking, water pollution, and air pollution for UBC incidence in Lebanon in 2016. However, limited data precluded sensitivity analyses, potentially affecting the robustness of the estimates.ResultsDuring this period, UBC ranked as the third most common cancer in males (12.9% of all new cancer cases) and the eighth most common in females (2.8% of all new cancer cases), excluding non-melanoma skin cancer. The average ASIRw was 28.8 in men and 6.6 in women, placing Lebanon among the countries with the highest UBC incidence rates globally. UBC incidence rates increased with age. Estimates indicated that 46.4% of UBC cases in the Lebanese population were attributed to current smoking, 8.6% to water pollution with disinfection byproducts, and 6.0% to air pollution with PM2.5.ConclusionThis study underscores the urgent need to mitigate UBC risk in Lebanon through tobacco control and by reducing exposure to preventable environmental and occupational risk factors, including tobacco smoking, water pollution, and air pollution.

Association of Cigarette Smoking and Alcohol Drinking With Risk of 12 Common Cancers Among Low-Income American Adults in the Southeastern United States

IntroductionCigarette smoking and alcohol drinking are well-known risk factors for various cancers. We aimed to determine a comprehensive profile of cancer risk associated with these lifestyle factors in predominantly low-income Americans.MethodsWe prospectively investigated the associations between cigarette smoking, alcohol drinking, and the risk of twelve cancer types among over 74 000 low-income Black and White adults from the Southern Community Cohort Study in the United States. We used the Cox proportional hazards models to estimate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for these associations.ResultsCompared to never smokers, current smokers had an increased HR for cancers of lung (HR: 14.14, 95% CI: 11.47-17.42), liver and bile duct (HR: 3.19, 95% CI: 2.40-4.25), kidney (HR: 1.47, 95% CI: 1.10-1.96), pancreas (HR: 1.88, 95% CI: 1.41-2.50), oral and pharynx (HR: 3.83, 95% CI: 2.70-5.42), and bladder (HR: 2.81, 95% CI: 1.92-4.11), and a reduced risk of prostate cancer (HR: 0.78, 95% CI: 0.68-0.89) and uterine cancer (HR: 0.45, 95% CI: 0.32-0.63); former smokers also exhibited elevated risks for cancers of lung, liver and bile duct, kidney, and bladder; however, a decreased risk for the lung, liver and bile duct, and bladder cancers was observed with longer durations of smoking cessation, with HRs from 9.71, 2.26, and 2.28 for a duration of <10 years down to 4.28, 1.58, and 1.42 for a duration of 10-19 years, respectively. Compared to never-drinkers, participants who consumed more than 2 drinks per day had increased risks of liver and bile duct cancer (HR: 1.66, 95% CI: 1.29-2.13) and oral and pharynx cancer (HR: 2.15, 95% CI: 1.58-2.91).ConclusionCigarette smoking and alcohol drinking were associated with an increased risk of multiple cancers. Our findings support efforts to control cigarette and alcohol consumption for cancer prevention in low-income U.S. populations.