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Silva-Santisteban A, Hernandez Woodbine MJ, Noriega MA, Rabinowitz LG, Grimshaw A, Farrell JJ, Chhoda A, Sawhney MS. Disparities in race, ethnicity, sex, and age inclusion in pancreatic cancer screening studies: a systematic review and meta-analysis. Gastrointest Endosc 2024; 100:1-16.e20. [PMID: 38432492 DOI: 10.1016/j.gie.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/12/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND AIMS Substantial differences exist in pancreatic cancer outcomes across ethnoracial stratifications. We sought to assess racial, ethnic, sex, and age reporting and inclusion of participants in pancreatic cancer screening studies. METHODS A systematic search of Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection from inception to 2022 was conducted. Original studies on pancreatic cancer screening were identified and assessed for reporting and inclusion on race, ethnicity, sex, and age. The pooled proportions of study participants for these characteristics were calculated and compared with population-based benchmarks. RESULTS Among 27 eligible pancreatic cancer screening studies, 26 reported data on either sex, race, or ethnicity, with a total of 5273 participants. Information on participant sex was reported by 26, race by 12, and ethnicity by 8 studies. Participants in these studies were almost all white (pooled proportion, 93.1%; 95% confidence interval [CI], 89.7-96.4) and non-Latino (pooled proportion, 97.4%; 95% CI, 94.0-100), and these groups were over-represented when compared with the general population. Female participants were well represented, with a pooled proportion of 63.2% (95% CI, 59.9-66.6). When reported, mean or median participant age was <60 years. Meta-regression revealed higher proportions of female participants in studies from the United States (P = .002). No association between increasing participation of racial or ethnic under-represented populations and study quality, ascending year of publication, or source of study funding was noted. CONCLUSIONS Substantial disparities in race, ethnicity, sex, and age reporting and inclusion in pancreatic cancer studies were noted, even among high-quality and publicly funded studies.
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Affiliation(s)
- Andy Silva-Santisteban
- Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Jose Hernandez Woodbine
- Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Marco Antonio Noriega
- Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Loren G Rabinowitz
- Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Alyssa Grimshaw
- Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - James J Farrell
- Division of Gastroenterology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ankit Chhoda
- Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Bogumil D, Stram D, Preston DL, Pandol SJ, Wu AH, McKean-Cowdin R, Conti DV, Setiawan VW. Excess pancreatic cancer risk due to smoking and modifying effect of quitting smoking: The Multiethnic Cohort Study. Cancer Causes Control 2024; 35:541-548. [PMID: 37924460 PMCID: PMC10838846 DOI: 10.1007/s10552-023-01811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/02/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Risk factors for pancreatic cancer include racial/ethnic disparities and smoking. However, risk trajectories by smoking history and race/ethnicity are unknown. We examined the association of smoking with pancreatic cancer by race/ethnicity to generate age-specific incidence estimates by smoking history. METHODS We modeled pancreatic cancer incidence by race/ethnicity, age, pack-years, and years-quit using an excess relative risk model for 182,011 Multiethnic Cohort participants. We tested heterogeneity of smoking variables and pancreatic cancer by race/ethnicity and predicted incidence by smoking history. RESULTS We identified 1,831 incident pancreatic cancer cases over an average 19.3 years of follow-up. Associations of pack-years (p interaction by race/ethnicity = 0.41) and years-quit (p interaction = 0.83) with pancreatic cancer did not differ by race/ethnicity. Fifty pack-years smoked was associated with 91% increased risk (95% CI 54%, 127%) relative to never smokers in the combined sample. Every year quit corresponded to 9% decreased excess risk (95% CI 2%, 15%) from pack-years smoked. Differences in baseline pancreatic cancer risk across racial/ethnic groups (p < 0.001) translated to large differences in risk for smokers at older ages across racial/ethnic groups (65-122 cases per 100,000 at age 70). CONCLUSION Smoking pack-years were positively associated with elevated pancreatic cancer risk. Predicted risk trajectories showed a high impact of smoking cessation at < 65 years. Although we did not identify significant heterogeneity in the association of pack-years or years quit with pancreatic cancer risk, current smoker risk varied greatly by race/ethnicity in later life due to large differences in baseline risk.
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Affiliation(s)
- David Bogumil
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1450 Biggy Street, Room 1517C, Los Angeles, CA, 90033, USA.
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
| | - Daniel Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1450 Biggy Street, Room 1517C, Los Angeles, CA, 90033, USA
| | | | - Stephen J Pandol
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Veterans Affairs, Los Angeles, CA, USA
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1450 Biggy Street, Room 1517C, Los Angeles, CA, 90033, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1450 Biggy Street, Room 1517C, Los Angeles, CA, 90033, USA
| | - David V Conti
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1450 Biggy Street, Room 1517C, Los Angeles, CA, 90033, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Veronica Wendy Setiawan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1450 Biggy Street, Room 1517C, Los Angeles, CA, 90033, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Mahabee-Gittens EM, Matt GE, Jandarov RA, Merianos AL. The Associations of Trans-3'-Hydroxy Cotinine, Cotinine, and the Nicotine Metabolite Ratio in Pediatric Patients with Tobacco Smoke Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095639. [PMID: 37174159 PMCID: PMC10177900 DOI: 10.3390/ijerph20095639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/09/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
(1) Background: Trans-3'-hydroxy cotinine (3HC) and cotinine (COT) are tobacco smoke exposure (TSE) biomarkers and the 3HC/COT ratio is a marker of CYP2A6 activity, an enzyme which metabolizes nicotine. The primary objective was to assess the associations of these TSE biomarkers with sociodemographics and TSE patterns in children who lived with ≥1 smoker. (2) Methods: A convenience sample of 288 children (mean age (SD) = 6.42 (4.8) years) was recruited. Multiple linear regression models were built to assess associations of sociodemographics and TSE patterns with urinary biomarker response variables: (1) 3HC, (2) COT, (3) 3HC+COT sum, and (4) 3HC/COT ratio. (3) Results: All children had detectable 3HC (Geometric Mean [GeoM] = 32.03 ng/mL, 95%CI = 26.97, 38.04) and COT (GeoM = 10.24 ng/mL, 95%CI = 8.82, 11.89). Children with higher cumulative TSE had higher 3HC and COT (β^ = 0.03, 95%CI = 0.01, 0.06, p = 0.015 and β^ = 0.03, 95%CI = 0.01, 0.05, p = 0.013, respectively). Highest 3HC+COT sum levels were in children who were Black (β^ = 0.60, 95%CI = 0.04, 1.17, p = 0.039) and who had higher cumulative TSE (β^ = 0.03, 95%CI = 0.01, 0.06, p = 0.015). Lowest 3HC/COT ratios were in children who were Black (β^ = -0.42, 95%CI = -0.78, -0.07, p = 0.021) and female (β^ = -0.32, 95%CI = -0.62, -0.01, p = 0.044). (4) Conclusion: Results indicate that there are racial and age-related differences in TSE, most likely due to slower nicotine metabolism in non-Hispanic Black children and in younger children.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA 92123, USA
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA
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Wang Z, Shi H, Peng L, Zhou Y, Wang Y, Jiang F. Gender differences in the association between biomarkers of environmental smoke exposure and developmental disorders in children and adolescents. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:84629-84639. [PMID: 35781659 DOI: 10.1007/s11356-022-21767-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Effects of environmental tobacco smoke (ETS) exposure on children and adolescent health outcomes have been attracted more and more attention. In the present study, we seek to examine the gender-specific difference association of environmental smoke exposure biomarkers and developmental disorders in children and adolescents aged 6-15 years. US nationally representative sample collected from the National Health and Nutrition Examination Survey (NHANES) 2007-2014 was enrolled (N = 4428). Developmental disorders (DDs) are defined as a positive answer to the question, "Does your child receive special education or early intervention services?" Serum cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) were utilized as acute and chronic exposure biomarkers of ETS, respectively. Participants with serum cotinine >0.015 ng/mL were considered as with acute ETS exposure, and participants with creatinine-adjusted NNAL >0.0006 ng/mL were considered as with chronic ETS exposure. A survey logistic regression model was used to estimate the association between ETS exposure biomarkers and DDs. Additive interaction was utilized to examine the interaction of gender and biomarkers of ETS. Overall, approximately 9% of children were defined as DDs, and 65% of children had serum cotinine and urinary NNAL levels above the limit of detection. In the adjusted models, the association of ETS exposure biomarkers with DDs was only observed in girls. Girls with low cotinine levels and high urinary NNAL levels had 2.074 (95% CI: 1.012-4.247) and 1.851 (95% CI: 1.049-3.265) times higher odds of being DDs than those without ETS exposure, respectively. However, the effects of boys and NNAL exposure on DDs have additively interacted. Our findings first provided strong evidence for gender differences in the association between two tobacco metabolites and DDs in children, disclosing the public health implications and economic burdens of environmental tobacco smoke exposure.
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Affiliation(s)
- Zixuan Wang
- Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, Jiangsu, China
| | - Hui Shi
- Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, Jiangsu, China
| | - Ling Peng
- Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, Jiangsu, China
| | - Yue Zhou
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Ying Wang
- Suzhou Center for Disease Prevention and Control, 72 Sanxiang Road, Suzhou, Jiangsu, China
| | - Fei Jiang
- School of public health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, Jiangsu, China.
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5
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Blackman E, Ashing K, Gibbs D, Kuo YM, Andrews A, Ramakodi M, Devarajan K, Bucci J, Jean-Louis G, Richards-Waritay O, Wilson B, Bowen C, Edi E, Tolbert V, Noumbissi R, Cabral DN, Oliver J, Roberts R, Tulloch-Reid M, Ragin C. The Cancer Prevention Project of Philadelphia: preliminary findings examining diversity among the African diaspora. ETHNICITY & HEALTH 2021; 26:659-675. [PMID: 30453751 PMCID: PMC6526085 DOI: 10.1080/13557858.2018.1548695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
Objective: Cancer mortality inequity among persons of African Ancestry is remarkable. Yet, Black inclusion in cancer biology research is sorely lacking and warrants urgent attention. Epidemiologic research linking African Ancestry and the African Diaspora to disease susceptibility and outcomes is critical for understanding the significant and troubling health disparities among Blacks. Therefore, in a cohort of diverse Blacks, this study examined differences in genetic ancestry informative markers (AIMs) in the DNA repair pathway and the cancer related biomarker 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL).Methods: Participants completed a questionnaire and provided bio-specimens. AIMs in or around DNA repair pathway genes were analyzed to assess differences in minor allele frequency (MAF) across the 3 ethnic subgroups. NNAL concentration in urine was measured among current smokers.Results: To date the cohort includes 852 participants, 88.3% being Black. Of the 752 Blacks, 51.3% were US-born, 27.8% were Caribbean-born, and 19.6% were Africa-born. Current and former smokers represented 14.9% and 10.0%, respectively. US-born Blacks were more likely to be smokers and poor metabolizers of NNAL. Two-way hierarchical clustering revealed MAF of AIMs differed across the 3 ethnic subgroups.Conclusion: Our findings are consistent with the emerging literature demonstrating Black heterogeneity underscoring African Ancestry genetic subgroup differences - specifically relevant to cancer. Further investigations, with data harmonization and sharing, are urgently needed to begin to map African Ancestry cancer biomarkers as well as race, and race by place\region comparative biomarkers to inform cancer prevention and treatment in the era of precision medicine.
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Affiliation(s)
- Elizabeth Blackman
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, Philadelphia, USA
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, USA
- African-Caribbean Cancer Consortium, Philadelphia, USA
| | - Kimlin Ashing
- Center of Community Alliance for Research & Education, Division of Health Equity, City of Hope Medical Center, Duarte, USA
| | - Denise Gibbs
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, Philadelphia, USA
- African-Caribbean Cancer Consortium, Philadelphia, USA
| | - Yin-Ming Kuo
- Cancer Epigenetics Program, Fox Chase Cancer Center-Temple Health, Philadelphia, USA
| | - Andrew Andrews
- Cancer Epigenetics Program, Fox Chase Cancer Center-Temple Health, Philadelphia, USA
| | - Meganathan Ramakodi
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, Philadelphia, USA
- African-Caribbean Cancer Consortium, Philadelphia, USA
- Department of Biology, Temple University, Philadelphia, USA
| | - Karthik Devarajan
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, USA
| | - Jackie Bucci
- Nutrition Program, City University of New York at Hunter College, New York, USA
- Temple University and Hunter College Cancer Health Disparity Research Institute Cancer Research Training Program, Fox Chase Cancer Center, Philadelphia, USA
| | | | | | - Barbara Wilson
- Caribbean Festival & Cultural Organization of Pennsylvania, Philadelphia, USA
| | - Carlene Bowen
- Thomas Jefferson University Hospital, Philadelphia, USA
| | - Eric Edi
- The Coalition of African Communities (AFRICOM), Philadelphia, USA
| | - Vera Tolbert
- The Coalition of African Communities (AFRICOM), Philadelphia, USA
| | | | - Daramola N. Cabral
- African-Caribbean Cancer Consortium, Philadelphia, USA
- Department of Science, Math, and Technology, SUNY Empire State College, Brooklyn, USA
| | - JoAnn Oliver
- African-Caribbean Cancer Consortium, Philadelphia, USA
- Capstone College of Nursing, Tuscaloosa, USA
| | - Robin Roberts
- African-Caribbean Cancer Consortium, Philadelphia, USA
- School of Clinical Medicine & Research, University of the West Indies, Nassau, Bahamas
- Princess Margaret Hospital, Nassau, Bahamas
| | - Marshall Tulloch-Reid
- African-Caribbean Cancer Consortium, Philadelphia, USA
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, Philadelphia, USA
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, USA
- African-Caribbean Cancer Consortium, Philadelphia, USA
- Nutrition Program, City University of New York at Hunter College, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University School of Medicine, Philadelphia, USA
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Huang BZ, Stram DO, Le Marchand L, Haiman CA, Wilkens LR, Pandol SJ, Zhang Z, Monroe KR, Setiawan VW. Interethnic differences in pancreatic cancer incidence and risk factors: The Multiethnic Cohort. Cancer Med 2019; 8:3592-3603. [PMID: 31066497 PMCID: PMC6601579 DOI: 10.1002/cam4.2209] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 12/14/2022] Open
Abstract
While disparity in pancreatic cancer incidence between blacks and whites has been observed, few studies have examined disparity in other ethnic minorities. We evaluated variations in pancreatic cancer incidence and assessed the extent to which known risk factors account for differences in pancreatic cancer risk among African Americans, Native Hawaiians, Japanese Americans, Latino Americans, and European Americans in the Multiethnic Cohort Study. Risk factor data were obtained from the baseline questionnaire. Cox regression was used to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for pancreatic cancer associated with risk factors and ethnicity. During an average 16.9-year follow-up, 1,532 incident pancreatic cancer cases were identified among 184,559 at-risk participants. Family history of pancreatic cancer (RR 1.97, 95% CI 1.50-2.58), diabetes (RR 1.32, 95% CI 1.14-1.54), body mass index ≥30 kg/m2 (RR 1.25, 95% CI 1.08-1.46), current smoking (<20 pack-years RR 1.43, 95% CI 1.19-1.73; ≥20 pack-years RR 1.76, 95% CI 1.46-2.12), and red meat intake (RR 1.17, 95% CI 1.00-1.36) were associated with pancreatic cancer. After adjustment for these risk factors, Native Hawaiians (RR 1.60, 95% CI 1.30-1.98), Japanese Americans (RR 1.33, 95% CI 1.15-1.54), and African Americans (RR 1.20, 95% CI 1.01-1.42), but not Latino Americans (RR 0.90, 95% CI 0.76-1.07), had a higher risk of pancreatic cancer compared to European Americans. Interethnic differences in pancreatic cancer risk are not fully explained by differences in the distribution of known risk factors. The greater risks in Native Hawaiians and Japanese Americans are new findings and elucidating the causes of these high rates may improve our understanding and prevention of pancreatic cancer.
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Affiliation(s)
- Brian Z. Huang
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCalifornia,Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCalifornia
| | - Daniel O. Stram
- Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Loic Le Marchand
- Epidemiology ProgramUniversity of Hawaii Cancer CenterHonoluluHawaii
| | - Christopher A. Haiman
- Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCalifornia,Norris Comprehensive Cancer CenterLos AngelesCalifornia
| | - Lynne R. Wilkens
- Epidemiology ProgramUniversity of Hawaii Cancer CenterHonoluluHawaii
| | - Stephen J. Pandol
- Division of Gastroenterology, Department of MedicineCedars‐Sinai Medical Center and Department of Veterans AffairsLos AngelesCalifornia
| | - Zuo‐Feng Zhang
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCalifornia
| | - Kristine R. Monroe
- Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Veronica Wendy Setiawan
- Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCalifornia,Norris Comprehensive Cancer CenterLos AngelesCalifornia
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7
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Ryan BM. Lung cancer health disparities. Carcinogenesis 2019; 39:741-751. [PMID: 29547922 DOI: 10.1093/carcin/bgy047] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/13/2018] [Indexed: 12/16/2022] Open
Abstract
Compared with all other racial and ethnic groups in the United States, African Americans are disproportionally affected by lung cancer, both in terms of incidence and survival. It is likely that smoking, as the main etiological factor associated with lung cancer, contributes to these disparities, but the precise mechanism is still unclear. This paper seeks to explore the history of lung cancer disparities and review to the literature regarding the various factors that contribute to them.
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Affiliation(s)
- Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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8
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Nomura SJO, Dash C, Rosenberg L, Palmer J, Adams-Campbell LL. Fruit and VegeTable Intake and Lung Cancer Incidence Among Black Women According to Cigarette Smoking Status. Nutr Cancer 2018; 70:904-912. [PMID: 30198773 DOI: 10.1080/01635581.2018.1491608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This project evaluated associations between fruit and vegetable intake, cigarette smoking and lung cancer incidence among U.S. Black women. The Black Women's Health Study is a prospective cohort study (analytic cohort = 46,889) among Black women between the ages 21 and 69 at baseline (1995). Fruit and vegetable intake and smoking history were ascertained via questionnaires at baseline and during follow-up. Associations between fruit and vegetable intake, smoking and lung cancer incidence (N = 306 incident cases through 2013) were evaluated using Cox proportional hazards regression. Among women in this cohort, 6.1% and 5.6% reported consuming at least three servings/d of fruit or vegetables, respectively. Smoking history was associated with increased lung cancer incidence. Being a current smoker of ≥15 cigarettes/d was associated with higher lung cancer incidence compared to never smokers (HR = 17.4, 95% CI: 11.5, 26.4). Fruit and vegetable was not associated with lung cancer incidence intake (≥5 vs. <3 servings/d, adjusted HR: 0.86, 95% CI: 0.54, 1.36). Associations between fruit and vegetable intake and lung cancer incidence did not differ by smoking history. Fruit and vegetable intake was low in this study population, but results do not support an association between fruit and vegetable intake and lung cancer incidence, regardless of smoking history.
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Affiliation(s)
- Sarah J O Nomura
- a Department of Oncology , Georgetown University , Washington , DC , USA
| | - Chiranjeev Dash
- a Department of Oncology , Georgetown University , Washington , DC , USA
| | - Lynn Rosenberg
- b Slone Epidemiology Center , Boston University , Boston , MA , USA
| | - Julie Palmer
- b Slone Epidemiology Center , Boston University , Boston , MA , USA
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Abstract
OBJECTIVES The objective of this study was to evaluate whether disparities in pancreatic cancer diagnosis, treatment, and survival are reduced in an integrated health system. METHODS We conducted a retrospective study (2006-2014) among patients with pancreatic cancer from Kaiser Permanente Southern California. Racial ethnic groups included non-Hispanic whites (NHW), non-Hispanic blacks (NHB), Hispanics, and Asians. We used multivariable and Cox regression analyses to evaluate disparities in diagnosis and treatment utilization (oncology care, surgery, time to surgery, chemotherapy) and overall survival, respectively. RESULTS Among 2103 patients, 54% were diagnosed with stage IV disease, 80% received oncology consultation, 20% received surgery with mean time to surgery 27 days (standard deviation, 36.8), 50.4% received chemotherapy. Mean overall survival was 8.6 months (standard deviation, 11.5). There were no differences in odds of stage IV diagnosis, oncology consultation, surgery, or time to surgery by racial ethnic group. Asians were more likely to receive chemotherapy (odds ratio, 1.59; 95% confidence interval [CI], 1.09-2.32) compared to NHW. NHB (hazard ratio, 0.78; 95% CI, 0.67-0.91) and Asians (hazard ratio, 0.81; 95% CI, 0.66-1.00) had improved survival compared to NHW. CONCLUSIONS Minorities were not disadvantaged in pancreatic cancer care. Improved health care coordination may improve current disparities.
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10
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Chen A, Krebs NM, Zhu J, Sun D, Stennett A, Muscat JE. Sex/Gender Differences in Cotinine Levels Among Daily Smokers in the Pennsylvania Adult Smoking Study. J Womens Health (Larchmt) 2017; 26:1222-1230. [PMID: 28872928 DOI: 10.1089/jwh.2016.6317] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study was conducted to determine sex/gender differences in smoke exposure and to quantify the role of potential predictors including puffing behaviors, nicotine dependence, and non-nicotinic factors. METHODS The Pennsylvania Adult Smoking Study (PASS) of 332 adult cigarette smokers utilized portable handheld topography devices to capture the smokers' profiles in a naturalistic environment. Sex/gender differences in salivary biomarkers were modeled using ANCOVA to account for measures of dependence (Fagerstrom Test for Nicotine Dependence, nicotine metabolite ratio [3-hydroxycotinine/cotinine]), and nondependence covariates including anthropomorphic factors and stress. The Blinder-Oaxaca method was used to decompose the sex/gender differences in nicotine uptake due to covariates. RESULTS Men had significantly higher cotinine levels (313.5 ng/mL vs. 255.8 ng/mL, p < 0.01), cotinine +3-hydroxycotinine levels, (0.0787 mol/L vs. 0.0675 mol/L, p = 0.01), puff volumes (52.95 mL vs. 44.77 mL, p < 0.01), and a lower nicotine metabolite ratio (0.396 vs. 0.475, p = 0.01) than women. The mean Fagerström Test for Nicotine Dependence score did not differ between men and women (p = 0.24). Women had a higher mean Hooked on Tobacco Checklist score than men (7.64 vs. 6.87, p < 0.01). In multivariate analysis, nicotine metabolite levels were not significantly different by sex. Decomposition results show that ten predictors can explain 83% of the sex/gender differences in cotinine uptake. Height was the greatest contributor to these differences, followed by average puff volume. Conclusion and Impact: The higher levels of nicotine metabolites in men, compared to women, can be explained by height, weight, puff volume, and nicotine metabolism.
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Affiliation(s)
- Allshine Chen
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Nicolle M Krebs
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Junjia Zhu
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Dongxiao Sun
- 2 Department of Pharmacology, Penn State University , Hershey, Pennsylvania
| | - Andrea Stennett
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Joshua E Muscat
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
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Huang W, Blount BC, Watson CH, Watson C, Chambers DM. Quantitative analysis of menthol in human urine using solid phase microextraction and stable isotope dilution gas chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1044-1045:200-205. [PMID: 28153673 DOI: 10.1016/j.jchromb.2016.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 11/26/2022]
Abstract
To accurately measure menthol levels in human urine, we developed a method using gas chromatography/electron ionization mass spectrometry with menthol-d4 stable isotope internal standardization. We used solid phase microextraction (SPME) headspace sampling for collection, preconcentration and automation. Conjugated forms of menthol were released using β-glucuronidase/sulfatase to allow for measuring total menthol. Additionally, we processed the specimens without using β-glucuronidase/sulfatase to quantify the levels of unconjugated (free) menthol in urine. This method was developed to verify mentholated cigarette smoking status to study the influence of menthol on smoking behaviour and exposure. This objective was accomplished with this method, which has no carryover or memory from the SPME fiber assembly, a method detection limit of 0.0017μg/mL, a broad linear range of 0.002-0.5μg/mL for free menthol and 0.01-10μg/mL for total menthol, a 7.6% precision and 88.5% accuracy, and an analysis runtime of 17min. We applied this method in analysis of urine specimens collected from cigarette smokers who smoke either mentholated or non-mentholated cigarettes. Among these smokers, the average total urinary menthol levels was three-fold higher (p<0.001) among mentholated cigarette smokers compared with non-mentholated cigarette smokers.
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Affiliation(s)
- Wenlin Huang
- School of Science and Technology, Georgia Gwinnett College, Lawrenceville, GA 30043, USA
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Clifford H Watson
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Christina Watson
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - David M Chambers
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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12
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Narayanapillai SC, Lin SH, Leitzman P, Upadhyaya P, Baglole CJ, Xing C. Dihydromethysticin (DHM) Blocks Tobacco Carcinogen 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)-Induced O 6-Methylguanine in a Manner Independent of the Aryl Hydrocarbon Receptor (AhR) Pathway in C57BL/6 Female Mice. Chem Res Toxicol 2016; 29:1828-1834. [PMID: 27728767 PMCID: PMC6532060 DOI: 10.1021/acs.chemrestox.6b00203] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is a key carcinogen responsible for tobacco smoke-induced lung carcinogenesis. Among the types of DNA damage caused by NNK and its metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), O6-methylguanine (O6-mG) is likely the most carcinogen in A/J mice. Results of our previous studies showed that levels of O6-mG and other types of NNAL-derived DNA damage were preferentially reduced in the lung of female A/J mice upon dietary treatment with dihydromethysticin (DHM), a promising lung cancer chemopreventive agent from kava. Such a differential blockage may be mediated via an increased level of NNAL glucuronidation, thereby leading to its detoxification. The potential of the aryl hydrocarbon receptor (AhR) as an upstream target of DHM mediating these events was evaluated herein using Ahr+/- and Ahr-/- C57BL/6 female mice because DHM was reported as an AhR agonist. DHM (0.05, 0.2, and 1.0 mg/g of diet) and dihydrokavain (DHK, an inactive analogue, 1.0 mg/g of diet) were given to mice for 7 days, followed by a single intraperitoneal dose of NNK at 100 mg/kg of body weight. The effects of DHM on the amount of O6-mG in the lung, on the urinary ratio of glucuronidated NNAL (NNAL-Gluc) and free NNAL, and on CYP1A1/2 activity in the liver microsomes were analyzed. As observed in A/J mice, DHM treatment significantly and dose-dependently reduced the level of O6-mG in the target lung tissue, but there were no significant differences in O6-mG reduction between mice from Ahr+/- and Ahr-/- backgrounds. Similarly, in both strains, DHM at 1 mg/g of diet significantly increased the urinary ratio of NNAL-Gluc to free NNAL and CYP1A1/2 enzymatic activity in liver with no changes detected at lower DHM dosages. Because none of these effects of DHM were dependent on Ahr status, AhR clearly is not the upstream target for DHM.
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Affiliation(s)
- Sreekanth C. Narayanapillai
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Shang-Hsuan Lin
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Pablo Leitzman
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Pramod Upadhyaya
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Carolyn J. Baglole
- Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
| | - Chengguo Xing
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, United States
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida 32610, United States
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13
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Wei B, Blount BC, Xia B, Wang L. Assessing exposure to tobacco-specific carcinogen NNK using its urinary metabolite NNAL measured in US population: 2011-2012. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2016; 26:249-56. [PMID: 25564369 PMCID: PMC4520776 DOI: 10.1038/jes.2014.88] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 05/22/2023]
Abstract
Carcinogenic tobacco-specific nitrosamines (TSNAs) such as 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) are found only in tobacco and derived products. Food and Drug Administration of the United States (US FDA) lists NNK as one of the 93 harmful and potentially harmful constituents (HPHCs) found in tobacco products and tobacco smoke. The aim of this study was to use the urinary concentration of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a major metabolite of NNK, to quantitatively estimate exposure to NNK in the US general population. In 2011-2012, the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) collected urine and serum samples from a representative sample of US residents. We used a serum cotinine cutoff of 10 ng/ml with combination of questionnaire data to select non-users from cigarette users and used self-reported data to determine different tobacco product user groups. We estimated the absorbed total daily dose of NNK using a probabilistic method based on a two-compartment model. The geometric mean (GM) for the daily dose of NNK among smokers aged 12-16 years was significantly higher than that for non-users at the same age stage exposed to second-hand smoke (SHS) (P<0.001). Among those exposed to SHS, the GM for daily dose of NNK in young children (6-11 years) was nearly three times of those for adults in the age range 21-59 years. Among cigarette users, non-Hispanic Whites had the highest NNK daily dose and Mexican Americans had the lowest levels. Exclusive snuff or chewing product users had significantly higher daily dose of NNK than did cigarette smokers. Our study found that the maximum daily dose of NNK for children aged from 6 to 11 years and that for a significant percentage of cigarette users, chewing product and snuff users were higher than an estimated provisional "reference" risk level.
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Affiliation(s)
- Binnian Wei
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin C Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Baoyun Xia
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lanqing Wang
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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14
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Collins BN, Nair US, Hovell MF, DiSantis KI, Jaffe K, Tolley NM, Wileyto EP, Audrain-McGovern J. Reducing Underserved Children's Exposure to Tobacco Smoke: A Randomized Counseling Trial With Maternal Smokers. Am J Prev Med 2015; 49:534-44. [PMID: 26028355 PMCID: PMC4575825 DOI: 10.1016/j.amepre.2015.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/06/2015] [Accepted: 03/13/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Addressing maternal smoking and child tobacco smoke exposure is a public health priority. Standard care advice and self-help materials to help parents reduce child tobacco smoke exposure is not sufficient to promote change in underserved populations. We tested the efficacy of a behavioral counseling approach with underserved maternal smokers to reduce infant's and preschooler's tobacco smoke exposure. DESIGN A two-arm randomized trial: enhanced behavior counseling (experimental) versus enhanced standard care (control). Assessment staff members were blinded. SETTING/PARTICIPANTS Three hundred randomized maternal smokers were recruited from low-income urban communities. Participants had a child aged <4 years exposed to two or more maternal cigarettes/day at baseline. INTERVENTION Philadelphia Family Rules for Establishing Smoke-free Homes (FRESH) included 16 weeks of counseling. Using a behavioral shaping approach within an individualized cognitive-behavioral therapy framework, counseling reinforced efforts to adopt increasingly challenging tobacco smoke exposure-protective behaviors with the eventual goal of establishing a smoke-free home. MAIN OUTCOME MEASURES Primary outcomes were end-of-treatment child cotinine and reported tobacco smoke exposure (maternal cigarettes/day exposed). Secondary outcomes were end-of-treatment 7-day point-prevalence self-reported cigarettes smoked/day and bioverified quit status. RESULTS Participation in FRESH behavioral counseling was associated with lower child cotinine (β=-0.18, p=0.03) and reported tobacco smoke exposure (β=-0.57, p=0.03) at the end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (β=-1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, χ(2)=10.56, p<0.01). There was no moderating effect of other smokers living at home. CONCLUSIONS FRESH behavioral counseling reduces child tobacco smoke exposure and promotes smoking quit rates in a highly distressed and vulnerable population. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02117947.
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Affiliation(s)
- Bradley N Collins
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania.
| | - Uma S Nair
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Katie I DiSantis
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania
| | - Karen Jaffe
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania
| | - Natalie M Tolley
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania
| | - E Paul Wileyto
- Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janet Audrain-McGovern
- Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Bergen AW, Krasnow R, Javitz HS, Swan GE, Li MD, Baurley JW, Chen X, Murrelle L, Zedler B. Total Exposure Study Analysis consortium: a cross-sectional study of tobacco exposures. BMC Public Health 2015; 15:866. [PMID: 26346437 PMCID: PMC4561475 DOI: 10.1186/s12889-015-2212-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 09/02/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Total Exposure Study was a stratified, multi-center, cross-sectional study designed to estimate levels of biomarkers of tobacco-specific and non-specific exposure and of potential harm in U.S. adult current cigarette smokers (≥one manufactured cigarette per day over the last year) and tobacco product non-users (no smoking or use of any nicotine containing products over the last 5 years). The study was designed and sponsored by a tobacco company and implemented by contract research organizations in 2002-2003. Multiple analyses of smoking behavior, demographics, and biomarkers were performed. Study data and banked biospecimens were transferred from the sponsor to the Virginia Tobacco and Health Research Repository in 2010, and then to SRI International in 2012, for independent analysis and dissemination. METHODS We analyzed biomarker distributions overall, and by biospecimen availability, for comparison with existing studies, and to evaluate generalizability to the entire sample. We calculated genome-wide statistical power for a priori hypotheses. We performed clinical chemistries, nucleic acid extractions and genotyping, and report correlation and quality control metrics. RESULTS Vital signs, clinical chemistries, and laboratory measures of tobacco specific and non-specific toxicants are available from 3585 current cigarette smokers, and 1077 non-users. Peripheral blood mononuclear cells, red blood cells, plasma and 24-h urine biospecimens are available from 3073 participants (2355 smokers and 719 non-users). In multivariate analysis, participants with banked biospecimens were significantly more likely to self-identify as White, to be older, to have increased total nicotine equivalents per cigarette, decreased serum cotinine, and increased forced vital capacity, compared to participants without. Effect sizes were small (Cohen's d-values ≤ 0.11). Power for a priori hypotheses was 57 % in non-Hispanic Black (N = 340), and 96 % in non-Hispanic White (N = 1840), smokers. All DNA samples had genotype completion rates ≥97.5 %; 68 % of RNA samples yielded RIN scores ≥6.0. CONCLUSIONS Total Exposure Study clinical and laboratory assessments and biospecimens comprise a unique resource for cigarette smoke health effects research. The Total Exposure Study Analysis Consortium seeks to perform molecular studies in multiple domains and will share data and analytic results in public repositories and the peer-reviewed literature. Data and banked biospecimens are available for independent or collaborative research.
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Affiliation(s)
- Andrew W Bergen
- Center for Health Sciences, SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025, USA.
| | - Ruth Krasnow
- Center for Health Sciences, SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025, USA.
| | - Harold S Javitz
- Center for Health Sciences, SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025, USA.
| | - Gary E Swan
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, 94305, USA.
| | - Ming D Li
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, 22911, USA.
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16
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Tong EK, Fagan P, Cooper L, Canto M, Carroll W, Foster-Bey J, Hébert JR, Lopez-Class M, Ma GX, Nez Henderson P, Pérez-Stable EJ, Santos L, Smith JH, Tan Y, Tsoh J, Chu K. Working to Eliminate Cancer Health Disparities from Tobacco: A Review of the National Cancer Institute's Community Networks Program. Nicotine Tob Res 2015; 17:908-23. [PMID: 26180215 PMCID: PMC4542844 DOI: 10.1093/ntr/ntv069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 03/13/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION In 2005, the National Cancer Institute funded the Community Networks Program (CNP), which aimed to reduce cancer health disparities in minority racial/ethnic and underserved groups through community-based participatory research, education, and training. The purpose of this study was to describe the CNP model and their tobacco-related work in community-based research, education, and training using a tobacco disparities research framework. METHODS We conducted a comprehensive review of the CNP tobacco-related activities including publications, published abstracts, research activities, trainee pilot studies, policy-related activities, educational outreach, and reports produced from 2005-2009. Two authors categorized the tobacco-related activities and publications within the framework. RESULTS Although there was no mandate to address tobacco, the CNPs produced 103 tobacco-related peer-reviewed publications, which reflects the largest proportion (12%) of all CNP cancer-related publications. Selected publications and research activities were most numerous under the framework areas "Psychosocial Research," "Surveillance," "Epidemiology," and "Treatment of Nicotine Addiction." Thirteen CNPs participated in tobacco control policymaking in mainstream efforts that affected their local community and populations, and 24 CNPs conducted 1147 tobacco-related educational outreach activities. CNP activities that aimed to build research and infrastructure capacity included nine tobacco-related pilot projects representing 16% of all CNP cancer-related pilot projects, and 17 publications acknowledging leveraged partnerships with other organizations, a strategy encouraged by the CNP. CONCLUSIONS The CNP is a promising academic-community model for working to eliminate tobacco-related health disparities. Future efforts may address scientific gaps, consider collaboration across groups, assess the extent of operationalizing community-based participatory research, and improve common tracking measures.
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Affiliation(s)
- Elisa K Tong
- Department of Internal Medicine, University of California, Davis, Sacramento, CA;
| | - Pebbles Fagan
- Cancer Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, HI
| | | | - Maria Canto
- Center for Research Capacity Building, National Institute of General Medical Sciences, Bethesda, MD
| | - William Carroll
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | - James R Hébert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | | | - Grace X Ma
- Department of Public Health, Temple University, Philadelphia, PA
| | | | - Eliseo J Pérez-Stable
- Department of Internal Medicine, University of California, San Francisco, San Francisco, CA
| | | | | | - Yin Tan
- Department of Public Health, Temple University, Philadelphia, PA
| | - Janice Tsoh
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Kenneth Chu
- Formerly National Cancer Institute's Center to Reduce Cancer Health Disparities (retired), Bethesda, MD
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17
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Ge GZ, Xu TR, Chen C. Tobacco carcinogen NNK-induced lung cancer animal models and associated carcinogenic mechanisms. Acta Biochim Biophys Sin (Shanghai) 2015; 47:477-87. [PMID: 26040315 DOI: 10.1093/abbs/gmv041] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/11/2015] [Indexed: 12/18/2022] Open
Abstract
Tobacco usage is a major risk factor in the development, progression, and outcomes for lung cancer. Of the carcinogens associated with lung cancer, tobacco-specific nitrosamines 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is among the most potent ones. The oncogenic mechanisms of NNK are not entirely understood, hindering the development of effective strategies for preventing and treating smoking-associated lung cancers. Here, we introduce the NNK-induced lung cancer animal models in different species and its potential mechanisms. Finally, we summarize several chemopreventive agents developed from these animal models.
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Affiliation(s)
- Guang-Zhe Ge
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
| | - Tian-Rui Xu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China
| | - Ceshi Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
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18
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Park SL, Carmella SG, Ming X, Vielguth E, Stram DO, Le Marchand L, Hecht SS. Variation in levels of the lung carcinogen NNAL and its glucuronides in the urine of cigarette smokers from five ethnic groups with differing risks for lung cancer. Cancer Epidemiol Biomarkers Prev 2015; 24:561-9. [PMID: 25542827 PMCID: PMC4355389 DOI: 10.1158/1055-9965.epi-14-1054] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Results of the Multiethnic Cohort (MEC) study demonstrated that, for the same quantity of cigarettes smoked, African Americans and Native Hawaiians have a higher risk of lung cancer compared with whites, whereas Latinos and Japanese Americans have a lower risk. We hypothesize that the uptake and/or metabolism of the lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) could explain the differences in lung cancer risk. METHODS We measured urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides and their sum (total NNAL), biomarkers of NNK uptake, in 2,252 smokers from the MEC. Ethnic-specific geometric means were compared adjusting for age at urine collection, sex, creatinine and total nicotine equivalents, a marker of total nicotine uptake. RESULTS African Americans had the highest median total NNAL levels (1.80 pmol/mL urine) and Japanese Americans had the lowest (0.914 pmol/mL urine), with intermediate values in the other three groups. Geometric mean of total NNAL in African Americans was also highest, and in Japanese Americans it was lowest; Japanese American geometric mean was statistically different from whites (P = 0.004). CONCLUSIONS African Americans had higher levels of total NNAL per mL urine than whites, while Japanese Americans had lower levels, consistent with lung cancer risk among smokers in these groups. However, our data were not consistent with the high and low lung cancer risks of Native Hawaiian and Latino smokers, respectively. IMPACT The higher lung cancer susceptibility of African-American smokers and the lower susceptibility of Japanese-American smokers compared with whites can be explained in part by exposure to the potent lung carcinogen NNK. Cancer Epidemiol Biomarkers Prev; 24(3); 561-9. ©2014 AACR.
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Affiliation(s)
- Sungshim L Park
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steven G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Xun Ming
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | | | - Daniel O Stram
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
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Wassenaar CA, Conti DV, Das S, Chen P, Cook EH, Ratain MJ, Benowitz NL, Tyndale RF. UGT1A and UGT2B genetic variation alters nicotine and nitrosamine glucuronidation in european and african american smokers. Cancer Epidemiol Biomarkers Prev 2014; 24:94-104. [PMID: 25277794 DOI: 10.1158/1055-9965.epi-14-0804] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Identifying sources of variation in the nicotine and nitrosamine metabolic inactivation pathways is important to understanding the relationship between smoking and cancer risk. Numerous UGT1A and UGT2B enzymes are implicated in nicotine and nitrosamine metabolism in vitro; however, little is known about their roles in vivo. METHODS Within UGT1A1, UGT1A4, UGT1A9, UGT2B7, UGT2B10, and UGT2B17, 47 variants were genotyped, including UGT2B10*2 and UGT2B17*2. The association between variation in these UGTs and glucuronidation activity within European and African American current smokers (n = 128), quantified as urinary ratios of the glucuronide over unconjugated compound for nicotine, cotinine, trans-3'-hydroxycotinine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), was investigated in regression models assuming a dominant effect of variant alleles. RESULTS Correcting for multiple testing, three UGT2B10 variants were associated with cotinine glucuronidation, rs2331559 and rs11726322 in European Americans and rs835309 in African Americans (P ≤ 0.0002). Additional variants predominantly in UGT2B10 were nominally associated with nicotine (P = 0.008-0.04) and cotinine (P = <0.001-0.02) glucuronidation in both ethnicities in addition to UGT2B10*2 in European Americans (P = 0.01, P < 0.001). UGT2B17*2 (P = 0.03) in European Americans and UGT2B7 variants (P = 0.02-0.04) in African Americans were nominally associated with 3HC glucuronidation. UGT1A (P = 0.007-0.01), UGT2B10 (P = 0.02), and UGT2B7 (P = 0.02-0.03) variants in African Americans were nominally associated with NNAL glucuronidation. CONCLUSIONS Findings from this initial in vivo study support a role for multiple UGTs in the glucuronidation of tobacco-related compounds in vivo, in particular UGT2B10 and cotinine glucuronidation. IMPACT Findings also provide insight into ethnic differences in glucuronidation activity, which could be contributing to ethnic disparities in the risk for smoking-related cancers. Cancer Epidemiol Biomarkers Prev; 24(1); 94-104. ©2014 AACR.
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Affiliation(s)
- Catherine A Wassenaar
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - David V Conti
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Soma Das
- Department of Human Genetics, University of Chicago, Chicago, Illinois
| | - Peixian Chen
- Department of Human Genetics, University of Chicago, Chicago, Illinois
| | - Edwin H Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Mark J Ratain
- Department of Medicine, Committee on Clinical Pharmacology and Pharmacogenomics, Cancer Research Center, University of Chicago, Chicago, Illinois
| | - Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California San Francisco, San Francisco, California. Department of Bioengineering and Therapeutic Science, University of California San Francisco, San Francisco, California
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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20
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Appleton S, Olegario RM, Lipowicz PJ. TSNA exposure from cigarette smoking: 18Years of urinary NNAL excretion data. Regul Toxicol Pharmacol 2014; 68:269-74. [DOI: 10.1016/j.yrtph.2013.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/12/2013] [Accepted: 07/28/2013] [Indexed: 02/05/2023]
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21
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Bethea TN, Rosenberg L, Charlot M, O'Connor GT, Adams-Campbell LL, Palmer JR. Obesity in relation to lung cancer incidence in African American women. Cancer Causes Control 2013; 24:1695-703. [PMID: 23744044 DOI: 10.1007/s10552-013-0245-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/29/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE Although a number of studies have found an inverse association between body mass index (BMI) and risk of lung cancer, there is little information on this relation in African Americans, who experience a higher incidence of lung cancer. METHODS We assessed the relation of BMI to incidence of lung cancer in the Black Women's Health Study, an ongoing prospective follow-up of 59,000 women in the USA. Cox proportional hazard models were used to estimate hazard ratios for various levels of BMI relative to BMI 18.5-24.9 kg/m2 ("normal weight") with adjustment for age, education, pack-years of smoking, and other covariates. Two other anthropometric measures, waist circumference (WC) and waist/hip ratio (WHR), were also assessed. A total of 323 primary lung cancer cases were identified from 1995 to 2011. RESULTS The hazard ratio (HR) for BMI ≥ 30 relative to BMI 18.5-24.9 was 0.69 (95% CI 0.51-0.92). As expected, cigarette smoking was strongly associated with increased risk of lung cancer. In analyses stratified by smoking status, the HR for BMI ≥ 30 relative to BMI 18.5-24.9 was 0.62 (0.38-1.00) among current smokers, 0.90 (0.56-1.42) among former smokers, and 0.83 (0.41-1.70) among never smokers (p for interaction = 0.28). Control for pack-years of smoking or age started smoking had little effect on the hazard ratios. WC and WHR were not materially associated with lung cancer risk. CONCLUSION Our results indicate that high BMI is associated with a lower risk of lung cancer in African American women, particularly among current smokers.
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Affiliation(s)
- Traci N Bethea
- Slone Epidemiology Center, Boston University, 1010 Commonwealth Avenue, Boston, MA, 02215, USA,
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Avila-Tang E, Al-Delaimy WK, Ashley DL, Benowitz N, Bernert JT, Kim S, Samet JM, Hecht SS. Assessing secondhand smoke using biological markers. Tob Control 2013; 22:164-71. [PMID: 22940677 PMCID: PMC3639350 DOI: 10.1136/tobaccocontrol-2011-050298] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 07/29/2012] [Indexed: 01/13/2023]
Abstract
Secondhand smoke exposure (SHSe) is a known cause of many adverse health effects in adults and children. Increasingly, SHSe assessment is an element of tobacco control research and implementation worldwide. In spite of decades of development of approaches to assess SHSe, there are still unresolved methodological issues; therefore, a multidisciplinary expert meeting was held to catalogue the approaches to assess SHSe and with the goal of providing a set of uniform methods for future use by investigators and thereby facilitate comparisons of findings across studies. The meeting, held at Johns Hopkins, in Baltimore, Maryland, USA, was supported by the Flight Attendant Medical Research Institute (FAMRI). A series of articles were developed to summarise what is known about self-reported, environmental and biological SHSe measurements. Non-smokers inhale toxicants in SHS, which are mainly products of combustion of organic materials and are not specific to tobacco smoke exposure. Biomarkers specific to SHSe are nicotine and its metabolites (e.g., cotinine), and metabolites of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Cotinine is the preferred blood, saliva and urine biomarker for SHSe. Cotinine and nicotine can also be measured in hair and toenails. NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol), a metabolite of NNK, can be determined in the urine of SHS-exposed non-smokers. The selection of a particular biomarker of SHSe and the analytic biological medium depends on the scientific or public health question of interest, study design and setting, subjects, and funding. This manuscript summarises the scientific evidence on the use of biomarkers to measure SHSe, analytical methods, biological matrices and their interpretation.
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Affiliation(s)
- Erika Avila-Tang
- 1Department of Epidemiology, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 4th Floor, Baltimore, MD 21205, USA.
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Abstract
INTRODUCTION Researchers have recently suggested that nicotine and carcinogen exposure as measured by biomarkers such as cotinine and NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) does not vary with cigarettes smoked per day (CPD) among Black smokers. Researchers have also suggested that nicotine exposure does not differ between menthol and nonmenthol smokers. In this study, we examine NNAL exposure for U.S. smokers by race, CPD, and menthol cigarette use. METHODS We analyzed urinary NNAL concentrations for more than 1500 everyday smokers participating in the National Health and Nutrition Examination Survey from 2007-2010. For purposes of comparison, we also analyzed serum cotinine concentrations for these smokers. We used linear regression analysis to estimate mean biomarker concentrations by CPD and race/ethnicity group and to examine the association between biomarker concentrations and menthol cigarette use by race/ethnicity group, controlling for other demographic and smoking characteristics. RESULTS Biomarker concentrations increased with CPD for White, Black, and Hispanic smokers although NNAL concentrations leveled off for Black smokers at lower CPD levels compared with other smokers. Mean NNAL concentrations were lower among menthol smokers compared with nonmenthol smokers among smokers overall (β = -0.165, p = .032) and White smokers (β = -0.207, p = .048). CONCLUSIONS We find evidence in national health survey data that nicotine and carcinogen exposure generally increases with CPD across race/ethnicity groups although the pattern of NNAL exposure differs by race/ethnicity group at high CPD levels. We also find evidence of differences in NNAL exposure for menthol smokers compared with nonmenthol smokers among smokers overall and White smokers.
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Affiliation(s)
- Brian Rostron
- Center for Tobacco Products, Food and Drug Administration, Rockville, MD 20850, USA.
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Liu BZ, Yao L, Zheng SJ, Wang WM, Zhu XL, Yang J. Development of a Sensitive Method for the Determination of 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol in Human Urine Using Solid-phase Extraction Combined with Ultrasound-assisted Dispersive Liquid-liquid Microextraction and LC-MS/MS Detection. J CHIN CHEM SOC-TAIP 2013. [DOI: 10.1002/jccs.201200646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Peters RJ, Kelder SH, Johnson RJ, Prokhorov AV, Meshack A, Jefferson T, Essien EJ. Cigarette smoking topography among alternative school youth: why African American youth smoke less but are at higher long-term risk. J Psychoactive Drugs 2012; 44:252-8. [PMID: 23061325 DOI: 10.1080/02791072.2012.703514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A paradox exists in health disparities research where African-American cigarette smokers consume fewer cigarettes per day, yet experience higher rates of tobacco-related disease compared to White American smokers. In this study we conducted focus group interviews among alternative high school youth (N = 78; age 18-19 years old) in an urban area in Southwest Texas to investigate if African-American youth smoke cigarettes differently than their White-American and Hispanic-American counterparts. The majority of African-American participants reported inhaling deeper and smoking their cigarettes "to the filter" because of their concern over wasting any part of an expensive cigarette. White and Hispanic respondents most often put out their cigarettes closer to the middle, and did not express concern about wasting cigarettes. The implication from this qualitative study is that because African Americans smoke differently they are exposed to a higher level of harmful particulate per cigarette. Further research on smoking topography is warranted.
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Affiliation(s)
- Ronald J Peters
- University of Texas-Houston, School of Public Health, 7000 Fannin, Suite 2618, Houston, TX 77030, USA.
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Wu CC, Su CT, Lee HL, Chung CJ, Huang CY, Pu YS, Lin P, Hsueh YM. Joint Effect of Arsenic Methylation Profile and NNK Metabolites on Urothelial Carcinoma. J Urol 2012; 188:1701-5. [DOI: 10.1016/j.juro.2012.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Indexed: 12/27/2022]
Affiliation(s)
- Chia-Chang Wu
- School of Public Health, College of Public Health and Nutrition, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Urology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
| | - Chien-Tien Su
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-Ling Lee
- Department of Chemistry, Fu Jen Catholic University, Hsinchuang, Taipei County, Taiwan
| | - Chi-Jung Chung
- Department of Health Risk Management, College of Public Health, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chao-Yuan Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Urology, National Taiwan University Hospital, College of Medicine National Taiwan University, Taipei, Taiwan
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital, College of Medicine National Taiwan University, Taipei, Taiwan
| | - Pinpin Lin
- Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli County, Taiwan
| | - Yu-Mei Hsueh
- School of Public Health, College of Public Health and Nutrition, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Radwan G, Hecht SS, Carmella SG, Loffredo CA. Tobacco-specific nitrosamine exposures in smokers and nonsmokers exposed to cigarette or waterpipe tobacco smoke. Nicotine Tob Res 2012; 15:130-8. [PMID: 22573723 DOI: 10.1093/ntr/nts099] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The causal relationship between tobacco smoking and a variety of cancers is attributable to the carcinogens that smokers inhale, including tobacco-specific nitrosamines (TSNAs). We aimed to assess the exposure to TSNAs in waterpipe smokers (WPS), cigarette smokers (CS), and nonsmoking females exposed to tobacco smoke. METHODS We measured 2 metabolites, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides (NNAl-Gluc) in the urine of males who were either current CS or WPS, and their wives exposed to either cigarette or waterpipe smoke in a sample of 46 subjects from rural Egypt. RESULTS Of the 24 current male smokers, 54.2% were exclusive CS and 45.8% were exclusive WPS. Among wives, 59.1% reported exposure to cigarette smoke and 40.9% to waterpipe smoke. The geometric mean of urinary NNAL was 0.19 ± 0.60 pmol/ml urine (range 0.005-2.58) in the total sample. Significantly higher levels of NNAL were observed among male smokers of either cigarettes or waterpipe (0.89 ± 0.53 pmol/ml, range 0.78-2.58 in CS and 0.21-1.71 in WPS) compared with nonsmoking wives (0.04 ± 0.18 pmol/ml, range 0.01-0.60 in CS wives, 0.05-0.23 in WPS wives, p = .000). Among males, CS had significantly higher levels of NNAL compared with WPS (1.22 vs. 0.62; p = .007). However, no significant difference was detected in NNAL levels between wives exposed to cigarette smoke or waterpipe smoke. CONCLUSIONS Cigarette smokers levels of NNAL were higher than WPS levels in males. Exposure to tobacco smoke was evident in wives of both CS and WPS. Among WPS, NNAL tended to increase with increasing numbers of hagars smoked/day.
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Affiliation(s)
- Ghada Radwan
- Department of Public Health, Cairo University, Cairo, Egypt.
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Rabinovitch N, Reisdorph N, Silveira L, Gelfand EW. Urinary leukotriene E₄ levels identify children with tobacco smoke exposure at risk for asthma exacerbation. J Allergy Clin Immunol 2011; 128:323-7. [PMID: 21807251 DOI: 10.1016/j.jaci.2011.05.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 04/14/2011] [Accepted: 05/06/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Children with asthma exposed to secondhand smoke (SHS) might be at higher risk for severe exacerbations, but biomarkers of susceptibility to SHS exposure have not been previously reported. OBJECTIVES We sought to assess the usefulness of urinary leukotriene E(4) (uLTE₄) levels in the prediction of increased risk of severe asthma exacerbations requiring emergency department (ED) or urgent care (UC) visits. METHODS Forty-four schoolchildren with moderate-to-severe asthma receiving inhaled corticosteroids were followed for 5 months with repeated measurements of uLTE₄ and monitoring of ED and UC visits. SHS exposure status was determined by using prestudy questionnaires and repeated measurements of urinary cotinine during the study. RESULTS Nine (45%) of 20 children with SHS exposure experienced a severe exacerbation requiring an ED or UC visit compared with 3 (12.5%) of 24 children without significant SHS exposure (relative risk, 3.6; 95% CI, 1.1-11.5; P = .02). The uLTE₄ level was a significant predictor of exacerbation risk in children exposed to SHS (area under the curve, 0.85; P = .003). Other predictors, such as nighttime symptom frequency, prebronchodilator and postbronchodilator lung function, and exhaled nitric oxide levels, were not related to exacerbations in this group. uLTE₄ levels at or greater than 106 pg/mg achieved 67% (6/9) sensitivity and 100% (11/11) specificity for predicting children with SHS exposure who required an ED or UC visit. CONCLUSIONS Children exposed to SHS are at increased risk for severe asthma exacerbations, despite use of inhaled corticosteroids. uLTE₄ levels identify children exposed to SHS at high risk for asthma exacerbations.
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Affiliation(s)
- Nathan Rabinovitch
- Department of Pediatrics, National Jewish Health, Denver, CO 80206, USA.
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Rabinovitch N, Silveira L, Gelfand EW, Strand M. The response of children with asthma to ambient particulate is modified by tobacco smoke exposure. Am J Respir Crit Care Med 2011; 184:1350-7. [PMID: 21868505 DOI: 10.1164/rccm.201010-1706oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Ambient particulate matter concentrations have been positively associated with urinary leukotriene E(4) (LTE(4)) levels and albuterol usage in children with asthma but interactions with environmental tobacco smoke (ETS) exposure have not been demonstrated despite obvious exposure to both pollutants in an urban setting. OBJECTIVES To assess the health effects of concurrent ETS and ambient particulate matter exposure in children with asthma. METHODS Albuterol usage and LTE(4) levels were monitored in 82 urban schoolchildren with asthma over three consecutive fall to spring school periods. Concentrations of morning maximum ambient particulate matter <2.5 μm in aerodynamic diameter (mmPM(2.5)) and urine cotinine levels were also measured daily. MEASUREMENTS AND MAIN RESULTS Albuterol usage and LTE(4) were related to mmPM(2.5) concentrations on days when urine cotinine levels were low (<10 ng/ml/mg creatinine); on these days, mean albuterol usage and LTE(4) increased up to 5 or 6% per 10 μg/m(3) increase in mmPM(2.5). In contrast, no significant relationship was observed when cotinine was high, although mean albuterol usage and LTE(4) levels were greater in this case. Model fits for LTE(4) levels as a function of mmPM(2.5) concentrations were improved when mmPM(2.5) concentrations were logged, suggesting a nonlinear dose-response relationship between particulate matter exposure concentrations and airway mediators of asthma, for which the relationship tends to flatten at higher concentrations. CONCLUSIONS This study suggests that ETS modifies the acute effects of low-level ambient PM(2.5) exposure on childhood asthma. This negative interaction, the smaller effect of particulate matter exposure in children exposed to higher ETS, may be related to a nonlinear dose-response relationship between asthma mediators and particulate exposures.
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Affiliation(s)
- Nathan Rabinovitch
- Division of Allergy/Immunology, Department of Pediatrics, National Jewish Health, Denver, CO 80206, USA.
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Caraballo RS, Holiday DB, Stellman SD, Mowery PD, Giovino GA, Muscat JE, Eriksen MP, Bernert JT, Richter PA, Kozlowski LT. Comparison of serum cotinine concentration within and across smokers of menthol and nonmenthol cigarette brands among non-Hispanic black and non-Hispanic white U.S. adult smokers, 2001-2006. Cancer Epidemiol Biomarkers Prev 2011; 20:1329-40. [PMID: 21430301 DOI: 10.1158/1055-9965.epi-10-1330] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Food and Drug Administration (FDA) is examining options for regulating menthol content in cigarettes. There are many pharmacologic properties of menthol that may facilitate exposure to tobacco smoke, and it has been suggested that the preference for menthol cigarettes in black smokers accounts for their higher cotinine levels. OBJECTIVE To assess cigarettes smoked per day-adjusted cotinine levels in relation to smoking a menthol or nonmenthol cigarette brand among non-Hispanic black and white U.S. adult smokers under natural smoking conditions. METHOD Serum cotinine concentrations were measured in 1,943 smokers participating in the 2001 to 2006 National Health and Nutrition Examination Surveys (NHANES). The effect of smoking a menthol brand on cigarettes smoked per day-adjusted serum cotinine levels in these two populations was modeled by adjusting for sex, age, number of smokers living in the home, body weight, time since last smoked, and FTC (Federal Trade Commission)-measured nicotine levels. The 8- or 12-digit Universal Product Code (UPC) on the cigarette label was used to determine the cigarette brand and whether it was menthol. RESULTS Smoking a menthol cigarette brand versus smoking a nonmenthol cigarette brand was not associated (P ≥ 0.05) with mean serum cotinine concentration in either black or white smokers. CONCLUSIONS The higher levels of cotinine observed in black smokers compared with white smokers are not explained by their higher preference for menthol cigarette brands. IMPACT Further studies like ours are needed to improve our ability to understand health consequences of future changes in tobacco product design.
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Affiliation(s)
- Ralph S Caraballo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Xia Y, Bernert JT, Jain RB, Ashley DL, Pirkle JL. Tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in smokers in the United States: NHANES 2007-2008. Biomarkers 2011; 16:112-9. [PMID: 21114376 DOI: 10.3109/1354750x.2010.533288] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of the tobacco-specific nitrosamine (TSNA) 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), has been measured in urine samples from all participants aged 6 years and older from the National Health and Nutrition Examination Survey 2007-2008. Participants with a serum cotinine concentration of ≥ 10 ng/mL were identified as tobacco users, primarily cigarette smokers. Regression models were developed to calculate geometric mean NNAL concentrations adjusted for serum cotinine, urinary creatinine, cigarettes per day, and Federal Trade Commission tar values of the cigarettes smoked. Significant differences were found by gender (p=0.003) and race/ethnicity (p=0.022 for non-Hispanic white versus non-Hispanic black smokers), but not by menthol type of the cigarettes. Females and non-Hispanic white smokers had the highest adjusted means for urinary NNAL (353 and 336 pg/mL, respectively). The results from this study demonstrated significant relationships between NNAL concentrations and serum cotinine (p<0.001) and urine creatinine (p<0.001). The joint effect of linear and quadratic terms for number of cigarettes smoked per day was also statistically significant (p=0.001). In addition to addressing current NNK exposure levels, these results will form a baseline for future estimates of tobacco users' exposure to this carcinogen.
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Affiliation(s)
- Yang Xia
- Division of Laboratory Science, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Bortner JD, Richie JP, Das A, Liao J, Umstead TM, Stanley A, Stanley BA, Belani CP, El-Bayoumy K. Proteomic profiling of human plasma by iTRAQ reveals down-regulation of ITI-HC3 and VDBP by cigarette smoking. J Proteome Res 2011; 10:1151-9. [PMID: 21186835 DOI: 10.1021/pr100925p] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Biomarkers in noninvasive fluids indicative of cigarette smoke's effects are urgently needed. In this pilot study, we utilized the proteomic approach, isobaric Tags for Relative and Absolute Quantitation (iTRAQ), to identify differentially expressed plasma proteins in healthy cigarette smokers compared to healthy nonsmokers; select proteins were further confirmed by immunoblot analysis. Significant, differentially expressed proteins identified in the plasma separated subjects based on their condition as smokers or nonsmokers. Several of the proteins identified in this study are associated with immunity and inflammatory responses and have been shown to be associated with tobacco-related diseases, including chronic obstructive pulmonary disease (COPD) and lung cancer. Proteins up-regulated in smokers included complement component 8 polypeptide chains α, β, and γ, and mannose-binding protein C, and proteins down-regulated included inter-α-trypsin inhibitor heavy chain H3 (ITI-HC3) and vitamin D-binding protein (VDBP). In addition, gelsolin and vitronectin, known tissue leakage proteins, were up- and down-regulated, respectively. Our results demonstrate for the first time that chronic cigarette smoking can influence the expression profile of the human plasma proteome. Proteins identified in this pilot study may serve as candidate biomarkers of diseases resulting from exposure to cigarette smoke in future molecular epidemiological studies.
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Affiliation(s)
- James D Bortner
- Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA
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Richie JP, Muscat JE, Ellison I, Calcagnotto A, Kleinman W, El-Bayoumy K. Association of selenium status and blood glutathione concentrations in blacks and whites. Nutr Cancer 2011; 63:367-75. [PMID: 21462082 PMCID: PMC3087599 DOI: 10.1080/01635581.2011.535967] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Selenium deficiency has been linked with increased cancer risk and, in some studies, selenium supplementation was protective against certain cancers. Previous studies have suggested that selenium chemoprevention may involve reduced oxidative stress through enhanced glutathione (GSH). Our objectives were to examine the relationships between selenium and GSH in the blood and the modifying effects of race and sex in free-living adults and individuals supplemented with selenium. Plasma selenium concentrations and free and bound GSH concentrations and γ-glutamyl cysteine ligase (GCL) activity in the blood were measured in 336 healthy adults (161 Blacks, 175 Whites). Plasma selenium and blood GSH were also measured in 36 healthy men from our previously conducted placebo-controlled trial of selenium-enriched yeast (247 μg/day for 9 mo). In free-living adults, selenium concentrations were associated with increased blood GSH concentration and GCL activity (P < 0.05). Further, selenium was significantly higher in Whites than in Blacks (P < 0.01). After 9 mo of supplementation, plasma selenium increased 114% in Whites and 50% in Blacks (P < 0.05), and blood GSH increased 35% in Whites (P < 0.05) but was unchanged in Blacks. These results indicate a direct association between selenium and GSH in the blood of both free-living and selenium-supplemented individuals, with race being an important modifying factor.
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Affiliation(s)
- John P Richie
- Department of Public Health Sciences, Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, Pennsylvania 17033, USA.
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Abstract
Pancreatic cancer is a relatively uncommon tumor, but even with early diagnosis, mortality rates are high, explaining why this form of cancer has now become a common cause of cancer mortality. There are no screening tests for early detection of pancreatic cancer. It is more common in men than women and is predominantly a disease of elderly people. There is wide variation in the incidence of pancreatic cancer around the world, suggesting that environmental factors are important in the pathogenesis. Smoking is the major known risk factor for pancreatic cancer, while dietary factors seem to be less important. Other possible risk factors include chronic pancreatitis, obesity and type 2 diabetes. Numerous inherited germ line mutations are associated with pancreatic cancer. Of these, hereditary pancreatitis confers the greatest risk, while BRCA2 mutations are the commonest inherited disorder. Polymorphisms in genes that control detoxification of environmental carcinogens and metabolic pathways may alter the risk of pancreatic cancer.
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Affiliation(s)
- Gábor Lakatos
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088.
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Ashley DL, O'Connor RJ, Bernert JT, Watson CH, Polzin GM, Jain RB, Hammond D, Hatsukami DK, Giovino GA, Cummings KM, McNeill A, Shahab L, King B, Fong GT, Zhang L, Xia Y, Yan X, McCraw JM. Effect of differing levels of tobacco-specific nitrosamines in cigarette smoke on the levels of biomarkers in smokers. Cancer Epidemiol Biomarkers Prev 2010; 19:1389-98. [PMID: 20501750 PMCID: PMC4565598 DOI: 10.1158/1055-9965.epi-10-0084] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Smokers are exposed to significant doses of carcinogens, including tobacco-specific nitrosamines (TSNA). Previous studies have shown significant global differences in the levels of TSNAs in cigarette smoke because of the variation in tobacco blending and curing practices around the world. METHODS Mouth-level exposure to 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) measured in cigarette butts and urinary concentrations of its major metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) were examined among 126 daily smokers in four countries over a 24-hour study period. RESULTS As mouth-level exposure of NNK increased, the urinary NNAL increased even after adjustment for other covariates (beta = 0.46, P = 0.004). The relationship between mouth-level exposure to nicotine and its salivary metabolite, cotinine, was not statistically significant (beta = 0.29, P = 0.057), likely because of the very limited range of differences in mouth-level nicotine exposure in this population. CONCLUSIONS We have shown a direct association between the 24-hour mouth-level exposure of NNK resulting from cigarette smoking and the concentration of its primary metabolite, NNAL, in the urine of smokers. Internal dose concentrations of urinary NNAL are significantly lower in smokers in countries that have lower TSNA levels in cigarettes such as Canada and Australia in contrast to countries that have high levels of these carcinogens in cigarettes, such as the United States. IMPACT Lowering the levels of NNK in the mainstream smoke of cigarettes through the use of specific tobacco types and known curing practices can significantly affect the exposure of smokers to this known carcinogen.
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Affiliation(s)
- David L Ashley
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Shah KA, Karnes HT. A review of the analysis of tobacco-specific nitrosamines in biological matrices. Crit Rev Toxicol 2010; 40:305-27. [PMID: 20210694 DOI: 10.3109/10408440903394435] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tobacco use constitutes a leading cause of mortality and morbidity worldwide. Tobacco-specific nitrosamines (TSNAs) are an important class of biomarkers for tobacco carcinogen uptake. The current review focuses on the issues and developments in analysis of these compounds in human biological matrices. The two most widely used techniques for TSNA bioanalysis are gas chromatography coupled with thermal energy analysis and liquid chromatography coupled with mass spectrometry, employing various sample preparation techniques. The review provides an overview of the tools and techniques currently available for TSNA bioanalysis that will help towards the ultimate goal of understanding the mechanisms of cancer caused by the use of tobacco products. A contrast and comparison of the important aspects of bioanalysis such as sample preparation, compound detection, and throughput is discussed for the thermal energy analysis- and mass spectrometry-based techniques. Complex sample extraction procedures, throughput, and the ability to validate are important issues of concern for the gas chromatography-thermal energy analysis-based methods. On the other hand, addressing ion suppression matrix effects remains an important challenge for hyphenated mass spectrometry-based methods. The review also provides an extensive summary of analytical procedures for various studies measuring tobacco-specific nitrosamines in different biological matrices.
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Affiliation(s)
- Kumar A Shah
- Department of Pharmaceutics, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia 23298, USA
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Abstract
Pancreatic cancer, although infrequent, has an exceptionally high mortality rate, making it one of the four or five most common causes of cancer mortality in developed countries. The incidence of pancreatic cancer varies greatly across regions, which suggests roles for lifestyle factors, such as diet, or environmental factors, such as vitamin D exposure. Smoking is the most common known risk factor, and is the cause of 20-25% of all pancreatic tumors. Alcohol does not seem to be a risk factor, unless it leads to chronic pancreatitis, which is a probable risk factor. Long-standing diabetes increases the risk of pancreatic cancer, but can also be an early manifestation of pancreatic tumors. 5-10% of patients with pancreatic cancer have an underlying germline disorder, while the remaining percentage of cancer cases is thought to be caused by somatic mutations. Some individual studies suggest that mutations in various polymorphic genes can lead to small increases in the risk of pancreatic cancer, but these findings need to be replicated. Rising prevalence of smoking in developing countries, improved diagnosis and increasing population longevity are all likely to increase the global burden of pancreatic cancer in the coming decades.
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Affiliation(s)
- Sara Raimondi
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Derby KS, Cuthrell K, Caberto C, Carmella S, Murphy SE, Hecht SS, Le Marchand L. Exposure to the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in smokers from 3 populations with different risks of lung cancer. Int J Cancer 2009; 125:2418-24. [PMID: 19598261 PMCID: PMC2779778 DOI: 10.1002/ijc.24585] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Native Hawaiian smokers are at higher risk and Japanese-American smokers at lower risk of lung cancer (LC), compared with white smokers, even after accounting for smoking history. Because variation in carcinogen exposure/metabolism may occur separately of smoking amount, we compared urinary biomarkers of uptake and detoxification of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)-a potent lung carcinogen-among 578 smokers in these ethnic/racial groups in Hawaii. We measured the NNK metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronide (NNAL-Gluc) and examined total NNAL (NNAL + NNAL-Gluc) and the NNAL detoxification ratio (NNAL-Gluc:NNAL). Native Hawaiians and Japanese-Americans had lower age- and sex-adjusted mean total NNAL, compared with whites. When further adjusting for urinary nicotine equivalents (the sum of nicotine, cotinine, trans-3'-hydroxycotinine and their respective glucuronides), only the difference between Japanese-Americans and whites was eliminated. Therefore, consistent with their lower LC risk, a lower cigarette smoke exposure explains the lower NNK dose of Japanese-Americans, but it does not explain that of Native Hawaiians. The mean detoxification ratio was also lower in Native Hawaiians and Japanese-Americans, compared with whites, even after adjusting for nicotine equivalents (p < 0.0001). Lower NNAL glucuronidation in Native Hawaiians might contribute to their increased LC risk; however, this is inconsistent with the low glucuronidation ratio similarly observed in the low-risk Japanese-American group and because Native Hawaiians had lower total NNAL levels. Thus, exposure and detoxification of NNK are unlikely to explain, by themselves, the differences in LC risk among the 3 populations studied.
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Affiliation(s)
- Kiersten S Derby
- Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI 96813, USA
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Gras-Aygon C, Daures JP, Bessaoud F, Tretarre B. [Female lung cancer trends, staging and histology in Hérault, France]. Rev Epidemiol Sante Publique 2009; 57:275-84. [PMID: 19596531 DOI: 10.1016/j.respe.2009.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 04/27/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In France, lung cancer is the third most common cancer and the third leading cause of cancer death in women. The main objective of this study is to analyse specificities of lung cancer in the female population in an administrative district in France, focusing on histology, staging and trends over time. METHODS Incidence data from 1987 to 2004 were extracted from the Hérault cancer registry. The variables of interest considered at diagnosis were stage, histology and age. Mortality data were extracted from the CépiDc-Inserm database for the same period. RESULTS Among the 6,650 patients studied, 16.8% were women. 18.3% of whom were aged less than 50 at diagnosis, (9.9% of men, p<0.001). Lung cancer incidence is increasing in the female population (+6.4% per year) as well as lung cancer mortality (+3.5% per year). This occurred faster for adenocarcinoma, young women and stages III-IV. CONCLUSION This population-based study confirmed the specific features of lung cancer in women: younger age at diagnosis, adenocarcinoma and stage at diagnosis with poor prognosis. These results raise the question of possible differences to lung cancer susceptibility between males and females.
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Affiliation(s)
- C Gras-Aygon
- Registre des Tumeurs de l'Hérault, Bâtiment Recherche-Parc Euromédecine, 208 Rue des Apothicaires, 34298 Montpellier Cedex 5, France.
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Ho MK, Mwenifumbo JC, Koudsi NA, Okuyemi KS, Ahluwalia JS, Benowitz NL, Tyndale RF. Association of nicotine metabolite ratio and CYP2A6 genotype with smoking cessation treatment in African-American light smokers. Clin Pharmacol Ther 2009; 85:635-43. [PMID: 19279561 PMCID: PMC3698861 DOI: 10.1038/clpt.2009.19] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cytochrome P450 2A6 (CYP2A6) is the main nicotine (NIC)-metabolizing enzyme in humans. We investigated the relationships between CYP2A6 genotype, baseline plasma trans- 3'-hydroxycotinine/cotinine (3HC/COT) (a phenotypic marker of CYP2A6 activity), and smoking behavior in African-American light smokers. Cigarette consumption, age of initiation, and dependence scores did not differ among 3HC/COT quartiles or CYP2A6 genotype groups. Slow metabolizers (SMs; both genetic and phenotypic) had significantly higher plasma NIC levels, suggesting that cigarette consumption was not reduced to adjust for slower rates of NIC metabolism. Individuals in the slowest 3HC/COT quartile had higher quitting rates with both placebo and NIC gum treatments (odds ratio 1.85, 95% confidence interval (CI) 1.08-3.16, P = 0.03). Similarly, the slowest CYP2A6 genotype group had higher quitting rates, although this trend did not reach significance (odds ratio 1.61, 95% CI 0.95-2.72, P = 0.08). The determination of the 3HC/COT ratio, and possibly CYP2A6 genotype, may be useful in the future for personalizing the choice of smoking cessation treatment in African-American light smokers.
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Affiliation(s)
- Man Ki Ho
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON
| | - Jill C. Mwenifumbo
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON
| | - Nael Al Koudsi
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON
| | | | | | - Neal L. Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Departments of Medicine and Biopharmaceutical Sciences, University of California, San Francisco, CA
| | - Rachel F. Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON
- Centre for Addiction & Mental Health, Toronto, ON
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Abstract
OBJECTIVES To correlate radon exposure with the incidence of pancreatic cancer (PC) and to ascertain the influence of race in this correlation. METHODS Age-standardized incidence rates (SIRs) of PC from 1992 to 2002, segregated by race, were obtained from the Surveillance, Epidemiology, and End Results database. The mean radon levels for each county were obtained from the Environmental Protection Agency map, which assigns each county to 1 of 3 categories based on radon potential. Aggregate radon exposure was correlated to the aggregate SIRs of PC. RESULTS The SIRs of PC in the United States ranged from 1.4 to 21.8/100,000 person-years. The highest rates for whites (19.6/100,000 person-years) and American Indians (594/100,000 person-years) were found in Guadalupe County, New Mexico; for African Americans (4845/100,000 person-years) in Worth County, Iowa; and for Asian Americans (3177/100,000 person-years) in Monroe County, Iowa. There was an insignificant correlation between radon exposure and overall incidence of PC (r = 0.042). A significant correlation existed between radon exposure and incidence of PC in African Americans, American Indians, and Asian Americans, but not in whites. CONCLUSIONS Radon exposure may be a significant risk factor for PC in African Americans, American Indians, and Asian Americans. Testing and mitigating homes for indoor radon may decrease PC incidence in these groups.
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Wong MD, Ettner SL, Boscardin WJ, Shapiro MF. The contribution of cancer incidence, stage at diagnosis and survival to racial differences in years of life expectancy. J Gen Intern Med 2009; 24:475-81. [PMID: 19189193 PMCID: PMC2659154 DOI: 10.1007/s11606-009-0912-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 12/17/2008] [Accepted: 12/30/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND African Americans have higher cancer mortality rates than whites. Understanding the relative contribution of cancer incidence, stage at diagnosis and survival after diagnosis to the racial gap in life expectancy has important implications for directing future health disparity interventions toward cancer prevention, screening and treatment. OBJECTIVE We estimated the degree to which higher cancer mortality among African Americans is due to higher incidence rates, later stage at diagnosis or worse survival after diagnosis. DESIGN Stochastic model of cancer incidence and survival after diagnosis. PATIENTS Surveillance and Epidemiology End Result cancer registry and National Health Interview Survey data. MEASUREMENTS Life expectancy if African Americans had the same cancer incidence, stage and survival after diagnosis as white adults. RESULTS African-American men and women live 1.47 and 0.91 fewer years, respectively, than whites as the result of all cancers combined. Among men, racial differences in cancer incidence, stage at diagnosis and survival after diagnosis account for 1.12 (95% CI: 0.52 to 1.36), 0.17 (95% CI: -0.03 to 0.33) and 0.21 (95% CI: 0.05 to 0.34) years of the racial gap in life expectancy, respectively. Among women, incidence, stage and survival after diagnosis account for 0.41 (95% CI: -0.29 to 0.60), 0.26 (95% CI: -0.06 to 0.40) and 0.31 (95% CI: 0.05 to 0.40) years, respectively. Differences in stage had a smaller impact on the life expectancy gap compared with the impact of incidence. Differences in cancer survival after diagnosis had a significant impact for only two cancers-breast (0.14 years; 95% CI: 0.05 to 0.16) and prostate (0.05 years; 95% CI 0.01 to 0.09). CONCLUSIONS In addition to breast and colorectal cancer screening, national efforts to reduce disparities in life expectancy should also target cancer prevention, perhaps through smoking cessation, and differences in survival after diagnosis among persons with breast and prostate cancer.
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Affiliation(s)
- Mitchell D Wong
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA 90024, USA.
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Muscat JE, Chen G, Knipe A, Stellman SD, Lazarus P, Richie JP. Effects of menthol on tobacco smoke exposure, nicotine dependence, and NNAL glucuronidation. Cancer Epidemiol Biomarkers Prev 2009; 18:35-41. [PMID: 19124478 DOI: 10.1158/1055-9965.epi-08-0744] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Menthol is a controversial cigarette additive because its physiologic or pharmacologic effects may possibly increase the risk for cancer and its targeted market is the Black community. In a community-based cross-sectional study on 525 Black and White volunteers, we compared levels of urinary and plasma cotinine, plasma thiocyanate, urinary 4-(N-nitrosomethylamino)-1-(3-pyridyl)-1-butanol (NNAL), and its detoxified form (NNAL-Gluc) between menthol and nonmenthol smokers. In regression models that adjusted for daily cigarette intake, no significant differences were observed in the concentration of these biomarkers by menthol status in both races. There was no significant association between high Fagerstrom nicotine dependence scores and the use of menthol cigarettes (odds ratio, 1.1; 95% confidence interval, 0.6-2.0), but an increased risk was observed with smoking a cigarette soon (<or=30 minutes) after waking (odds ratio, 2.1; 95% confidence interval, 1.0-3.8). The ratio of NNAL-Gluc to NNAL, a possible indicator of lung cancer risk, was significantly lower in menthol versus nonmenthol smokers. The NNAL-Gluc/NNAL ratio was 34% lower in Whites (P < 0.01) and 22% lower in Blacks. In subsequent human liver microsome studies, menthol inhibited the rate of NNAL-O-glucuronidation and NNAL-N-glucuronidation. Collectively, these results show that menthol does not affect biological exposure to tobacco smoke constituents but indicates that menthol might inhibit the detoxification of the potent lung carcinogen NNAL.
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Affiliation(s)
- Joshua E Muscat
- Penn State College of Medicine, Department of Public Health Science, Hershey, PA 17033, USA.
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Nichenametla SN, Ellison I, Calcagnotto A, Lazarus P, Muscat JE, Richie JP. Functional significance of the GAG trinucleotide-repeat polymorphism in the gene for the catalytic subunit of gamma-glutamylcysteine ligase. Free Radic Biol Med 2008; 45:645-50. [PMID: 18549827 PMCID: PMC2562218 DOI: 10.1016/j.freeradbiomed.2008.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 05/02/2008] [Accepted: 05/15/2008] [Indexed: 01/22/2023]
Abstract
Gamma-glutamylcysteine ligase (GCL) is the rate-limiting enzyme in glutathione (GSH) synthesis. A GAG-repeat polymorphism in the 5' UTR of the gene coding for the catalytic subunit of GCL (GCLC) has been associated with altered GSH levels in vitro. Thus, we hypothesized that this polymorphism is associated with altered GCL activity and blood GSH levels in vivo. A total of 256 healthy United States black and white adults were genotyped for the GAG polymorphism and blood GSH levels were measured. In a subset of 107 individuals, blood GCL activity was determined. Five alleles with 4, 7, 8, 9, and 10 GAG repeats were observed. The most prevalent genotype was 7/9 (40%) followed by 7/7 (32%) and 9/9 (11%). GSH levels were 15% lower in 9/9 individuals than 7/9 individuals (P=0.05). GCL activity was 21% lower in 9/9 individuals than 7/7 individuals (P=0.04). A decreasing trend of GCL activity was observed in the order of 7/7>7/9>9/9 (P=0.04). These findings show that 9/9 individuals have lower blood GSH levels, which is likely due to a decrease in GCL activity. Such individuals might be more susceptible to oxidative stress-related diseases than individuals with other genotypes.
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Affiliation(s)
- Sailendra N Nichenametla
- Cancer Prevention and Control Program, Penn State Cancer Institute, Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA
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Kabat GC, Kim M, Hunt JR, Chlebowski RT, Rohan TE. Body mass index and waist circumference in relation to lung cancer risk in the Women's Health Initiative. Am J Epidemiol 2008; 168:158-69. [PMID: 18483121 DOI: 10.1093/aje/kwn109] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Investigators in several epidemiologic studies have observed an inverse association between body mass index (BMI) and lung cancer risk, while others have not. The authors used data from the Women's Health Initiative to study the association of anthropometric factors with lung cancer risk. Over 8 years of follow-up (1998-2006), 1,365 incident lung cancer cases were ascertained among 161,809 women. Cox proportional hazards models were used to estimate hazard ratios adjusted for covariates. Baseline BMI was inversely associated with lung cancer in current smokers (highest quintile vs. lowest: hazard ratio (HR) = 0.62, 95% confidence interval (CI): 0.42, 0.92). When BMI and waist circumference were mutually adjusted, BMI was inversely associated with lung cancer risk in both current smokers and former smokers (HR = 0.40 (95% CI: 0.22, 0.72) and HR = 0.61 (95% CI: 0.40, 0.94), respectively), and waist circumference was positively associated with risk (HR = 1.56 (95% CI: 0.91, 2.69) and HR = 1.50 (95% CI: 0.98, 2.31), respectively). In never smokers, height showed a borderline positive association with lung cancer. These findings suggest that in smokers, BMI is inversely associated with lung cancer risk and that waist circumference is positively associated with risk.
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Affiliation(s)
- Geoffrey C Kabat
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, USA.
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Arheart KL, Lee DJ, Dietz NA, Wilkinson JD, Clark JD, LeBlanc WG, Serdar B, Fleming LE. Declining Trends in Serum Cotinine Levels in US Worker Groups: the Power of Policy. J Occup Environ Med 2008; 50:57-63. [DOI: 10.1097/jom.0b013e318158a486] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stepanov I, Hecht SS, Lindgren B, Jacob P, Wilson M, Benowitz NL. Relationship of human toenail nicotine, cotinine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol to levels of these biomarkers in plasma and urine. Cancer Epidemiol Biomarkers Prev 2007; 16:1382-6. [PMID: 17627002 DOI: 10.1158/1055-9965.epi-07-0145] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Recently, we developed sensitive and quantitative methods for analysis of the biomarkers of tobacco smoke exposure nicotine, cotinine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in human toenails. In this study, we further evaluated the newly developed toenail biomarkers by investigating their relationship to demographic factors, reported exposure, plasma nicotine, cotinine, and trans-3'-hydroxycotinine, and urinary NNAL. Toenails of 105 smokers, mean age 38.9 years (range, 19-68), were analyzed. Fifty-five (53.4%) were male, with approximately equal numbers of Whites and African-Americans. The average number of cigarettes smoked per day was 18 (range, 5-50). There was no effect of age or gender on the toenail biomarkers. Toenail NNAL was higher in White than in African-American participants (P = 0.019). Toenail nicotine and toenail cotinine correlated significantly with cigarettes smoked per day (r = 0.24; P = 0.015 and r = 0.26; P = 0.009, respectively). Toenail nicotine correlated with plasma nicotine (r = 0.39; P < 0.001); toenail cotinine correlated with plasma cotinine (r = 0.45; P < 0.001) and plasma trans-3'-hydroxycotinine (r = 0.30; P = 0.008); and toenail NNAL correlated with urine NNAL (r = 0.53; P = 0.005). The results of this study provide essential validation data for the use of toenail biomarkers in investigations of the role of chronic tobacco smoke exposure in human cancer.
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Affiliation(s)
- Irina Stepanov
- The Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA.
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Melikian AA, Djordjevic MV, Chen S, Richie J, Stellman SD. Effect of delivered dosage of cigarette smoke toxins on the levels of urinary biomarkers of exposure. Cancer Epidemiol Biomarkers Prev 2007; 16:1408-15. [PMID: 17627005 DOI: 10.1158/1055-9965.epi-06-1097] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Urinary metabolites of tobacco smoke toxins are often used as biomarkers for the evaluation of active and passive exposure to cigarette smoke toxins. In a study of healthy smokers, we investigated concentrations of urinary biomarkers in relation to concentrations of selected toxins in mainstream cigarette smoke as determined by machine smoking of cigarettes in a manner that mimics an individual's smoking behavior (topography). Concentrations of nicotine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, and benzo(a)pyrene, in mainstream smoke determined under human smoking conditions, and their urinary metabolites cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, and 1-hydroxypyrene were established for 257 individuals who smoked low-yield (0.1-0.8 mg Federal Trade Commission nicotine/cigarette; mean, 0.66; n = 87), medium-yield (0.9-1.2 mg nicotine/cigarette; mean, 1.1; n = 109), and high-yield cigarettes (nicotine, >1.3 mg nicotine/cigarette; mean, 1.41; n = 61). Levels of urinary metabolites expressed per unit of delivered parent compounds decreased with increased smoke emissions. In smokers of low-, medium-, and high-yield cigarettes, the respective cotinine (ng/mg creatinine)-to-nicotine (mg/d) ratios were 89.4, 77.8, and 57.1 (low versus high; P = 0.06); the 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (pmol/mg creatinine)-to-4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (ng/d) ratios were 0.81, 0.55, and 0.57 (low versus high; P = 0.05); and the 1-hydroxypyrene (pg/mg creatinine)-to-benzo(a)pyrene (ng/d) ratios were 1.55, 1.13, and 0.97 (low versus high; P = 0.008). Similarly, means of cotinine per unit of delivered nicotine in smokers who consumed <20 cigarettes per day was 3.5-fold higher than in those who smoked >20 cigarettes per day. Likewise, a negative correlation was observed between cotinine-to-nicotine ratios and delivered doses of nicotine in subgroups of smokers who used the identical brand of cigarette, namely a filter tip-vented Marlboro (r = -0.59), which is a popular brand among Euro-Americans, and Newport (r = -0.37), a menthol-flavored cigarette without filter tip vents that is preferred by African-Americans. Thus, the intensity of the exposures significantly affects the levels of urinary biomarkers of exposure and should be taken into account in the evaluation of human exposure to cigarette smoke toxins.
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Affiliation(s)
- Assieh A Melikian
- Department of Environmental Medicine, New York University School of Medicine, Tuxedo, NY 10987, USA.
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49
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Gallagher CJ, Muscat JE, Hicks AN, Zheng Y, Dyer AM, Chase GA, Richie J, Lazarus P. The UDP-Glucuronosyltransferase 2B17 Gene Deletion Polymorphism: Sex-Specific Association with Urinary 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanol Glucuronidation Phenotype and Risk for Lung Cancer. Cancer Epidemiol Biomarkers Prev 2007; 16:823-8. [PMID: 17416778 DOI: 10.1158/1055-9965.epi-06-0823] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone is a potent and abundant procarcinogen found in tobacco smoke, and glucuronidation of its major metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), by UDP-glucuronosyltransferases (UGT) including UGT2B17 is an important mechanism for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone detoxification. Both copies of the UGT2B17 gene are deleted in approximately 10% of Whites and the deletion is associated with a reduction in NNAL glucuronidation activity in vitro. In this study, we examined the effects of the UGT2B17 deletion (0/0) on NNAL glucuronidation rates in a sample of 82 healthy cigarette smokers and further examined its effects on lung cancer risk in a separate case-control study. In the healthy smokers study, a lower urinary ratio of NNAL-glucuronide to NNAL was observed in women with the UGT2B17 deletion (0/0) as compared with women with either the wild-type or heterozygous genotypes (P = 0.058). There were no significant differences in this ratio by genotype in men (P = 0.597). In the case-control study of 398 lung cancer patients and 697 community controls, the UGT2B17 deletion (0/0) was associated with a significant increase in risk of lung cancer in women (odds ratio, 2.0; 95% confidence interval, 1.01-4.0). The risk for the subset of women with lung adenocarcinoma was 2.8 (95% confidence interval, 1.2-6.3). The deletion was not associated with other lung histologic types in women and was not associated with the risk for any lung histologic types in men. The association of the UGT2B17 deletion with increased lung adenocarcinoma in women is consistent with its association with decreased NNAL glucuronidation rates in women and with studies showing that NNAL is a selective inducer of lung adenocarcinoma in experimental animals.
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Affiliation(s)
- Carla J Gallagher
- Department of Health Evaluation Sciences, Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA
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Pinsky PF. Racial and ethnic differences in lung cancer incidence: how much is explained by differences in smoking patterns? (United States). Cancer Causes Control 2006; 17:1017-24. [PMID: 16933052 DOI: 10.1007/s10552-006-0038-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 05/05/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Lung cancer rates vary considerably among U.S. racial/ethnic groups. We quantitatively analyzed the extent to which these differences can be attributed to differential patterns of smoking. METHODS We utilized survey data from the U.S. Census to estimate smoking patterns in the following racial/ethnic groups: non-Hispanic whites, non-Hispanic blacks, Hispanics, Asian/Pacific Islanders and American Indians. We used several dose-response models of smoking and lung cancer to predict relative lung cancer rates in these groups based on reported smoking patterns, specifically, on smoking status (current, former, never), cigarettes per day, age started, and age quit (for former smokers). Predicted rates were compared to observed population rates for these groups. RESULTS Black men had slightly lower predicted lung cancer rates than white men, but had 35-47% higher observed rates. Hispanic men had predicted rates about 25% lower than whites but observed rates 50% lower than whites; predicted rates for Hispanic women were 50% lower than whites compared to observed rates that were 60-70% lower. For Asian/Pacific Islanders, predicted and observed rates relative to whites were comparable. Predicted rates for American Indians were slightly higher than whites while observed rates were about 40% lower. CONCLUSION Differences in smoking largely explain lower lung cancer rates in Asian/Pacific Islanders relative to whites and partially explain lower rates in Hispanics compared to whites. Increased rates in black men and decreased rates in American Indians are not explained by differences in smoking.
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Affiliation(s)
- Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA.
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