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Urback AL, Martens K, McMurry HS, Sharma A, Citti C, DeLoughery TG, Shatzel JJ. Serum ferritin and risk of colonic neoplasia: Implications for the workup and treatment of iron deficiency. Eur J Haematol 2024; 113:138-145. [PMID: 38757452 PMCID: PMC11222030 DOI: 10.1111/ejh.14229] [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: 03/05/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024]
Abstract
Iron deficiency is the most common extraintestinal sign of colonic neoplasia, including colorectal cancer (CRC) and other lower gastrointestinal pathology. Both upper endoscopy and colonoscopy is usually recommended in the work-up of patients with unexplained iron deficiency, particularly in men and postmenopausal women. As the incidence of early-onset CRC (age <50 years) rises in the United States, there is an increasing need to identify risk predictors to aid in the early detection of CRC. It remains unknown if serum ferritin (SF), and what specific threshold, can be used as a marker to stratify those at risk for CRC and other lower gastrointestinal pathology. In this current review of the literature, we aimed to review guidelines for diagnostic workup of colonic neoplasia in the setting of iron deficiency and examine the association and specific thresholds of SF and risk of CRC by age. Some of the published findings are conflicting, and conclusions specific to younger patients are limited. Though further investigation is warranted, the cumulative findings suggest that SF, in addition to considering the clinical context and screening guidelines, may have potential utility in the assessment of colonic neoplasia.
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Affiliation(s)
- Adam L Urback
- Division of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Hannah Stowe McMurry
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Anil Sharma
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon, USA
| | - Caitlin Citti
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas G DeLoughery
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
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2
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Krieg S, Loosen S, Krieg A, Luedde T, Roderburg C, Kostev K. Association between iron deficiency anemia and subsequent stomach and colorectal cancer diagnosis in Germany. J Cancer Res Clin Oncol 2024; 150:53. [PMID: 38289465 PMCID: PMC10827837 DOI: 10.1007/s00432-023-05534-z] [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: 09/21/2023] [Accepted: 11/26/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Iron deficiency anemia (IDA) is the most common form of anemia worldwide, resulting in a high burden of disease. Accumulating evidence suggests that IDA is associated with the development of gastrointestinal (GI) cancers. METHODS Data from the IDA database (IQVIA) of primary care practices in Germany of adult patients first diagnosed with IDA between January 2005 and December 2021 were retrospectively analyzed and compared with a 1:1 propensity score-adjusted cohort without IDA. Study outcomes were first stomach cancer or colorectal cancer (CRC) diagnosis up to 10 years after the index date as a function of IDA. RESULTS A total of 122,502 individuals with IDA and 122,502 individuals without IDA were included. The 10-year cumulative incidence of CRC was 1.4% in the IDA patients compared to 0.8% in the cohort without IDA (p < 0.001). Regression analysis revealed a significant association between IDA and subsequent CRC (HR 2.05; 95% CI 1.83-2.30). Stomach cancer was diagnosed in 0.3% of IDA patients compared to 0.2% in the non-IDA cohort during the 10-year follow-up period (p = 0.002). However, this was significant only in the age group > 80 years (HR 2.73; 95% CI 1.60-4.67) and in men (HR 1.90; 95% CI 1.38-2.61). CONCLUSION These findings add to the literature and suggest an association between IDA and GI cancers. The extent to which this association is due to GI bleeding or other pathophysiological processes that may be caused by IDA requires further investigation, particularly experimental studies.
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Affiliation(s)
- Sarah Krieg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Sven Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225, Duesseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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3
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Estêvão D, da Cruz-Ribeiro M, Cardoso AP, Costa ÂM, Oliveira MJ, Duarte TL, da Cruz TB. Iron metabolism in colorectal cancer: a balancing act. Cell Oncol (Dordr) 2023; 46:1545-1558. [PMID: 37273145 DOI: 10.1007/s13402-023-00828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second deadliest malignancy worldwide. Current dietary habits are associated with increased levels of iron and heme, both of which increase the risk of developing CRC. The harmful effects of iron overload are related to the induction of iron-mediated pro-tumorigenic pathways, including carcinogenesis and hyperproliferation. On the other hand, iron deficiency may also promote CRC development and progression by contributing to genome instability, therapy resistance, and diminished immune responses. In addition to the relevance of systemic iron levels, iron-regulatory mechanisms in the tumor microenvironment are also believed to play a significant role in CRC and to influence disease outcome. Furthermore, CRC cells are more prone to escape iron-dependent cell death (ferroptosis) than non-malignant cells due to the constitutive activation of antioxidant genes expression. There is wide evidence that inhibition of ferroptosis may contribute to the resistance of CRC to established chemotherapeutic regimens. As such, ferroptosis inducers represent promising therapeutic drugs for CRC. CONCLUSIONS AND PERSPECTIVES This review addresses the complex role of iron in CRC, particularly in what concerns the consequences of iron excess or deprivation in tumor development and progression. We also dissect the regulation of cellular iron metabolism in the CRC microenvironment and emphasize the role of hypoxia and of oxidative stress (e.g. ferroptosis) in CRC. Finally, we underline some iron-related players as potential therapeutic targets against CRC malignancy.
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Affiliation(s)
- Diogo Estêvão
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Cancer Research Institute, Ghent University, Ghent, Belgium
| | - Miguel da Cruz-Ribeiro
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Ana P Cardoso
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Ângela M Costa
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Maria J Oliveira
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP - Faculty of Medicine, Pathology Department, University of Porto, Porto, Portugal
| | - Tiago L Duarte
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Tânia B da Cruz
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
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Ying J, Wang B, Han S, Song J, Liu K, Chen W, Sun X, Mao Y, Ye D. Genetically predicted iron status was associated with the risk of prostate cancer. Front Oncol 2022; 12:959892. [PMID: 36561528 PMCID: PMC9763611 DOI: 10.3389/fonc.2022.959892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Observational studies have reported a relationship between iron status and the risk of prostate cancer. However, it remains uncertain whether the association is causal or due to confounding or reverse causality. To further clarify the underlying causal relationship, we conducted a Mendelian randomization (MR) analysis. Methods We selected three genetic variants (rs1800562, rs1799945, and rs855791) closely correlated with four iron status biomarkers (serum iron, log-transformed ferritin, transferrin saturation, and transferrin) as instrumental variables. Summary statistics for prostate cancer were obtained from the Prostate Cancer Association Group to Investigate Cancer Associated Alterations in the Genome consortium including 79,148 cases and 61,106 controls of European ancestry. The inverse-variance weighted (IVW) method was conducted primarily to estimate the association of genetically predicted iron status and the risk of prostate cancer, supplemented with simple-median, weighted-median and maximum-likelihood methods as sensitivity analysis. MR-Egger regression was used to detect directional pleiotropy. We also conducted a meta-analysis of observational studies to assess the associations between iron status and the risk of prostate cancer. Results Genetically predicted increased iron status was associated with the decreased risk of prostate cancer, with odds ratio of 0.91 [95% confidence interval (CI): 0.84, 0.99; P = 0.035] for serum iron, 0.81 (95% CI: 0.65, 1.00; P = 0.046) for log- transformed ferritin, 0.94 (95% CI: 0.88, 0.99; P = 0.029) for transferrin saturation, and 1.15 (95% CI: 0.98, 1.35; P = 0.084) for transferrin (with higher transferrin levels representing lower systemic iron status), using the inverse-variance weighted method. Sensitivity analyses produced consistent associations, and MR-Egger regression indicated no potential pleiotropy. Our replication analysis based on FinnGen research project showed compatible results with our main analysis. Results from our meta-analysis similarly showed that serum ferritin [standardized mean difference (SMD): -1.25; 95% CI: -2.34, -0.16; P = 0.024] and transferrin saturation (SMD: -1.19; 95% CI: -2.34, -0.05; P = 0.042) were lower in patients with prostate cancer compared with that in controls. Discussion Our study suggests a protective role of iron in the risk of prostate cancer, further investigations are required to clarify the underlying mechanisms.
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Affiliation(s)
- Jiacheng Ying
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Binyan Wang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuyang Han
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie Song
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ke Liu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Weiwei Chen
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaohui Sun
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yingying Mao
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China,*Correspondence: Ding Ye, ; Yingying Mao,
| | - Ding Ye
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China,*Correspondence: Ding Ye, ; Yingying Mao,
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5
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Kim H, Han K, Ko SH, An HJ. Association between serum ferritin levels and colorectal cancer risk in Korea. Korean J Intern Med 2022; 37:1205-1215. [PMID: 36278251 PMCID: PMC9666249 DOI: 10.3904/kjim.2022.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The concentration of serum ferritin, a storage form of iron, may be associated with carcinogenesis in various cancers. There are only limited studies on the relationship between serum ferritin levels and colorectal cancer (CRC) risk, especially in the Asian population. This study aimed to analyze the association between CRC incidence and serum ferritin levels. METHODS This was a national cohort study that used health checkup and insurance claims data of the Korean population. CRC incidence according to the serum ferritin level was analyzed during 2008-2018 in 17,116 participants. RESULTS The hazard ratio (HR) of CRC incidence decreased as serum ferritin levels increased (Q1: HR, 1.000 [95% confidence interval [CI], reference]; Q2: HR, 0.811 [95% CI, 0.558 to 1.178]; Q3: HR, 0.654 [95% CI, 0.442 to 0.968]; Q4: HR, 0.443 [95% CI, 0.285 to 0.687]; p = 0.0026). In subgroup analysis, 40 to 64 years of age, sex, body mass index of < 25 kg/ m2, presence of metabolic syndrome, absence of diabetes mellitus, and absence of anemia had HRs of < 0.5 (95% CI) in the highest quartiles compared with that in the lowest quartiles. CONCLUSION This study shows an inverse association between serum ferritin and CRC risk. Serum ferritin measurement can aid in identifying young adults requiring active CRC screening.
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Affiliation(s)
- Hyunho Kim
- Division of Medical Oncology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon,
Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon,
Korea
| | - Ho Jung An
- Division of Medical Oncology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon,
Korea
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Abstract
Excessive gut luminal iron contributes to the initiation and progression of colorectal cancer. However, emerging evidence suggests that reduced iron intake and low systemic iron levels are also associated with the pathogenesis of colorectal cancer. This is important because patients with colorectal cancer often present with iron deficiency. Iron is necessary for appropriate immunological functions; hence, iron deficiency may hinder cancer immunosurveillance and potentially modify the tumor immune microenvironment, both of which may assist cancer development. This is supported by studies showing that patients with colorectal cancer with iron deficiency have inferior outcomes and reduced response to therapy. Here, we provide an overview of the immunological consequences of iron deficiency and suggest ensuring adequate iron therapy to limit these outcomes.
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Affiliation(s)
- Oliver Phipps
- O. Phipps, M.J. Brookes, and H.O. Al-Hassi are with the Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Matthew J Brookes
- O. Phipps, M.J. Brookes, and H.O. Al-Hassi are with the Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, United Kingdom.,Royal Wolverhampton Hospitals NHS Trust, Gastroenterology Unit Wolverhampton, Wolverhampton, United Kingdom
| | - Hafid O Al-Hassi
- O. Phipps, M.J. Brookes, and H.O. Al-Hassi are with the Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, United Kingdom
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Aksan A, Farrag K, Aksan S, Schroeder O, Stein J. Flipside of the Coin: Iron Deficiency and Colorectal Cancer. Front Immunol 2021; 12:635899. [PMID: 33777027 PMCID: PMC7991591 DOI: 10.3389/fimmu.2021.635899] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Iron deficiency, with or without anemia, is the most frequent hematological manifestation in individuals with cancer, and is especially common in patients with colorectal cancer. Iron is a vital micronutrient that plays an essential role in many biological functions, in the context of which it has been found to be intimately linked to cancer biology. To date, however, whereas a large number of studies have comprehensively investigated and reviewed the effects of excess iron on cancer initiation and progression, potential interrelations of iron deficiency with cancer have been largely neglected and are not well-defined. Emerging evidence indicates that reduced iron intake and low systemic iron levels are associated with the pathogenesis of colorectal cancer, suggesting that optimal iron intake must be carefully balanced to avoid both iron deficiency and iron excess. Since iron is vital in the maintenance of immunological functions, insufficient iron availability may enhance oncogenicity by impairing immunosurveillance for neoplastic changes and potentially altering the tumor immune microenvironment. Data from clinical studies support these concepts, showing that iron deficiency is associated with inferior outcomes and reduced response to therapy in patients with colorectal cancer. Here, we elucidate cancer-related effects of iron deficiency, examine preclinical and clinical evidence of its role in tumorigenesis, cancer progression and treatment response. and highlight the importance of adequate iron supplementation to limit these outcomes.
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Affiliation(s)
- Aysegül Aksan
- Institute of Nutritional Science, Justus-Liebig University, Giessen, Germany.,Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt, Germany.,Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany
| | - Karima Farrag
- Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
| | - Sami Aksan
- Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
| | - Oliver Schroeder
- Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
| | - Jürgen Stein
- Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt, Germany.,Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
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8
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Meng Y, Sun J, Yu J, Wang C, Su J. Dietary Intakes of Calcium, Iron, Magnesium, and Potassium Elements and the Risk of Colorectal Cancer: a Meta-Analysis. Biol Trace Elem Res 2019; 189:325-335. [PMID: 30171595 DOI: 10.1007/s12011-018-1474-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to analyze the existing studies and to investigate the relationship between the risk of colorectal cancer (CRC) and intakes of four individual dietary elements calcium (Ca), iron (Fe), magnesium (Mg), and potassium (K). All relevant articles in both Chinese and English were searched and collected from PubMed, Web of Science, and Chinese National Knowledge Infrastructure databases up to December 17, 2017. There were 29 eligible literatures selected for further meta-analysis, including 14 cohort studies and 15 case-control studies. The meta-analysis of cohort studies indicated that the high intakes of dietary Ca and Mg were negatively associated with the risk of CRC, as the hazard ratios (HR) were 0.76 (95% confidence interval (CI) 0.72, 0.80) and 0.80 (95% CI 0.73, 0.87), respectively. Nevertheless, high intake of dietary heme Fe was positively correlated to the incidence of colon cancer (HR = 1.01, 95% CI 0.82, 1.19) and rectal cancer (HR = 1.04, 95% CI 0.67, 1.42). A meta-analysis of case-control studies indicated that high intakes of dietary Ca, Mg, and K were negatively related with the occurrence of CRC, because the odds ratios (OR) were 0.36 (95% CI 0.32, 0.40), 0.80 (95% CI 0.63, 0.98) and 0.97 (95% CI 0.74, 1.21), respectively. However, high Fe intake from diet was positively correlated with the rising increasing of CRC (OR = 1.04, 95% CI 0.91, 1.18). More research is needed to indicate the risk relationship between element intake and CRC.
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Affiliation(s)
- Yu Meng
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan, 430071, Hubei, People's Republic of China
| | - Jiantao Sun
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan, 430071, Hubei, People's Republic of China
| | - Jun Yu
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan, 430071, Hubei, People's Republic of China
| | - Chunhong Wang
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan, 430071, Hubei, People's Republic of China
| | - Jianmei Su
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Donghu Road 115, Wuhan, 430071, Hubei, People's Republic of China.
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Different forms and sources of iron in relation to colorectal cancer risk: a case-control study in China. Br J Nutr 2019; 121:735-747. [PMID: 30688185 DOI: 10.1017/s0007114519000023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have examined the association of various types of Fe with colorectal cancer risk. The aim of this study was to investigate different forms and sources of Fe in relation to colorectal cancer risk in a Chinese population. A total of 2138 patients with colorectal cancer and 2144 sex- and age-matched (5-year interval) controls were recruited from July 2010 to November 2017. Dietary information was assessed by face-to-face interviews using a validated FFQ. Multivariable logistic regression was used to estimate the OR and 95 % CI on models. Intake of Fe from plants and Fe from white meat were inversely associated with the risk of colorectal cancer, while haem Fe and Fe from red meat were positively associated with colorectal cancer risk. The multivariable OR for the highest quartile v. the lowest quartile were 0·72 (95 % CI 0·59, 0·87, P trend<0·001) for Fe from plants, 0·54 (95 % CI 0·45, 0·66, P trend<0·001) for Fe from white meat, 1·26 (95 % CI 1·04, 1·53, P trend=0·005) for haem Fe and 1·83 (95 % CI 1·49, 2·24, P trend<0·001) for Fe from red meat intake, respectively. However, no significant association was found between the consumption of total dietary Fe, non-haem Fe, Fe from meat and colorectal cancer risk. This study showed that lower intake of Fe from plants and white meat, as well as higher intake of haem Fe and Fe from red meat, were associated with colorectal cancer risk in a Chinese population.
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10
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You W, Henneberg M. Prostate Cancer Incidence is Correlated to Total Meat Intake– a Cross-National Ecologic Analysis of 172 Countries. Asian Pac J Cancer Prev 2018; 19:2229-2239. [PMID: 30139230 PMCID: PMC6171413 DOI: 10.22034/apjcp.2018.19.8.2229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/17/2018] [Indexed: 02/05/2023] Open
Abstract
Objective: To examine the association of total meat (animal flesh) consumption to prostate cancer incidence (PC61) at population level. Subjects and Methods: Data from 172 countries were extracted for analysis. Associations between country specific per capita total meat intake and PC61 incidence at country level were examined using Pearson’s r and Spearman rho, partial correlation, stepwise multiple linear regression analyses with ageing, GDP, Is (index of magnitude of prostate cancer gene accumulation at population level), obesity prevalence and urbanization included as the confounding factors. Countries were also grouped for regional association analysis. The data were log-transformed for analysis in SPSS. Microsoft Excel, and ANOVA Post hoc Scheffe tests were applied to calculate and compare mean differences between country groupings. Results: Worldwide, total meat intake was strongly and positively associated with PC61 incidence in Pearson’s r (r= 0.595, p<0.001) and Spearman rho (r= 0.637, p<0.001) analyses. This relationship remained significant in partial correlation (r= 0.295, p<0.001) when ageing, GDP, Is, obesity prevalence and urbanization were kept statistically constant. GDP was weakly and insignificantly associated with PC61 when total meat intake was kept statistically constant. Stepwise multiple linear regression identified that total meat was a significant predictor of PC61 with total meat intake and all the five confounders included as the independent variables (R2=0.417). Post hoc Scheffe tests revealed nine significant mean differences of PC61 between the six WHO regions, but all disappeared when the contributing effect of total meat on PC61 incidence rate was removed. GDP was not identified as the statistically significant predictor of PC61 in either of the models including or excluding total meat as the independent variable. Conclusions: Total meat intake is an independent predictor of PC61 worldwide, and the determinant of regional variation of PC61. The longitudinal cohort studies are proposed to explore the association further.
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Affiliation(s)
- Wenpeng You
- Adelaide Medical School, University of Adelaide, Australia.
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11
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Banjari I, Hjartåker A. Dietary sources of iron and vitamin B12: Is this the missing link in colorectal carcinogenesis? Med Hypotheses 2018; 116:105-110. [DOI: 10.1016/j.mehy.2018.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/04/2018] [Accepted: 05/07/2018] [Indexed: 12/22/2022]
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12
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Aleksandrova K, Schlesinger S, Fedirko V, Jenab M, Bueno-de-Mesquita B, Freisling H, Romieu I, Pischon T, Kaaks R, Gunter MJ, Dahm CC, Overvad K, Rostgaard-Hansen AL, Tjønneland A, Trichopoulou A, Bamia C, Lagiou P, Agnoli C, Mattiello A, Bradbury K, Khaw KT, Riboli E, Boeing H. Metabolic Mediators of the Association Between Adult Weight Gain and Colorectal Cancer: Data From the European Prospective Investigation into Cancer and Nutrition (EPIC) Cohort. Am J Epidemiol 2017; 185:751-764. [PMID: 28387787 DOI: 10.1093/aje/kww194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/01/2016] [Indexed: 12/28/2022] Open
Abstract
Evidence indicates that gaining weight in adult life is associated with an elevated risk of colorectal cancer; however, biological mechanisms that may explain this association remain unclear. We evaluated the mediation effect of 20 different biomarkers on the relationship between adult weight gain and colorectal cancer, using data from a prospective nested case-control study of 452 incident cases diagnosed between 1992 and 2003 and matched within risk sets to 452 controls within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The proportions of mediated effects (%) were estimated on the basis of differences in percent effect changes in conditional logistic regression models with and without additional adjustment for individual biomarkers. Greater adult weight gain (≥300 g/year vs. <300 g/year) was associated with a higher risk of colon cancer (multivariable-adjusted relative risk = 1.54, 95% confidence interval: 1.07, 2.24) but not rectal cancer (relative risk = 1.07, 95% confidence interval: 0.68, 1.66). This association was accounted for mostly by attained waist circumference (reduction of 61%) and by the biomarkers soluble leptin receptor (reduction of 43%) and glycated hemoglobin (reduction of 28%). These novel data suggest that the observed association between adult weight gain and colon cancer could be primarily explained by attained abdominal fatness and biomarkers of metabolic dysfunction.
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13
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Ashmore JH, Rogers CJ, Kelleher SL, Lesko SM, Hartman TJ. Dietary Iron and Colorectal Cancer Risk: A Review of Human Population Studies. Crit Rev Food Sci Nutr 2017; 56:1012-20. [PMID: 25574701 DOI: 10.1080/10408398.2012.749208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Iron is an essential micronutrient that is involved in many redox processes and serves as an integral component in various physiological functions. However, excess iron can cause tissue damage through its pro-oxidative effects, potentiating the development of many diseases such as cancer through the generation of reactive oxidative species. The two major forms of iron in the diet are heme and nonheme iron, both of which are found in several different foods. In addition to natural food sources, intake of nonheme iron may also come from fortified foods or in supplement form. This review summarizes the results of human population studies that have examined the role of dietary iron (heme and nonheme), heme iron alone, and iron from supplements in colorectal carcinogenesis.
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Affiliation(s)
- Joseph H Ashmore
- a Department of Pharmaceutical Sciences , Washington State University , Spokane , Washington , USA
| | - Connie J Rogers
- b Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA
| | - Shannon L Kelleher
- b Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA
| | - Samuel M Lesko
- c Northeast Regional Cancer Institute , Scranton , Pennsylvania , USA.,d The Commonwealth Medical College , Scranton , Pennsylvania , USA
| | - Terryl J Hartman
- e Department of Epidemiology , Rollins School of Public Health and Winship Cancer Institute, Emory University , Atlanta , Georgia , USA
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Chua AC, Knuiman MW, Trinder D, Divitini ML, Olynyk JK. Higher concentrations of serum iron and transferrin saturation but not serum ferritin are associated with cancer outcomes. Am J Clin Nutr 2016; 104:736-42. [PMID: 27488234 DOI: 10.3945/ajcn.115.129411] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 06/16/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Although the carcinogenic potential of iron has been shown, evidence from observational studies that have linked serum iron variables and cancer outcomes has been inconsistent. OBJECTIVE We investigated whether higher iron concentrations increased risk of cancer outcomes. DESIGN A prospective examination of iron biomarkers as independent risk factors for cancer was assessed in 1597 men and 1795 women aged 25-79 y who participated in the 1994/1995 Busselton Health Survey and had relevant data, no history of cancer before the survey, and serum ferritin concentrations ≥20 μg/L. Follow-up for incident cancers and death from cancer was available to 2010. Proportional hazards regression modeling was performed to investigate if iron status predicted cancer incidence and mortality. RESULTS After adjustments for age, smoking, drinking, anthropometric and biochemical variables, or menopausal status (breast cancer), higher serum iron concentrations and transferrin saturation were associated with increased risks of incident nonskin cancer [HR for iron: 1.83 (95% CI: 1.21, 2.76; P < 0.01); HR for transferrin saturation: 1.68 (95% CI: 1.18, 2.38; P < 0.01)] including breast cancer [HR for iron: 2.45 (95% CI:1.12, 5.34; P < 0.05); HR for transferrin saturation: 1.90 (95% CI:1.02, 3.56; P < 0.05)] in women. Transferrin saturation was also associated with a greater risk of cancer death (HR: 2.48; 95% CI: 1.28, 4.82; P < 0.01). In men, higher iron concentrations were associated with reduced risks of incident nonskin cancer (HR: 0.65; 95% CI: 0.42, 0.99; P < 0.05) including colorectal cancer (HR: 0.34; 95% CI: 0.12, 0.95; P < 0.05). There was no association between serum iron and colorectal cancer risk in women. Serum ferritin was not associated with cancer risk or cancer death. CONCLUSIONS Higher transferrin saturation or serum iron concentrations were associated with increased nonskin cancer risk and increased risk of cancer death. Conversely, in men, higher serum iron concentrations were associated with decreased risk of nonskin cancer. The molecular basis for the observed differences in the association between serum iron and nonskin cancer risk is unclear.
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Affiliation(s)
- Anita Cg Chua
- School of Medicine and Pharmacology, The University of Western Australia, Fiona Stanley Hospital, Murdoch, Australia; Harry Perkins Institute of Medical Research, Murdoch, Australia;
| | - Matthew W Knuiman
- School of Population Health, The University of Western Australia, Crawley, Australia
| | - Debbie Trinder
- School of Medicine and Pharmacology, The University of Western Australia, Fiona Stanley Hospital, Murdoch, Australia; Harry Perkins Institute of Medical Research, Murdoch, Australia
| | - Mark L Divitini
- School of Population Health, The University of Western Australia, Crawley, Australia
| | - John K Olynyk
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, Australia; Department of Gastroenterology and Hepatology, Fremantle Hospital, Fremantle, Australia; Faculty of Health Sciences, Curtin University, Bentley, Australia; and School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
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Lee S, Song A, Eo W. Serum Ferritin as a Prognostic Biomarker for Survival in Relapsed or Refractory Metastatic Colorectal Cancer. J Cancer 2016; 7:957-64. [PMID: 27313786 PMCID: PMC4910588 DOI: 10.7150/jca.14797] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/16/2016] [Indexed: 12/26/2022] Open
Abstract
Background: This study investigated the prognostic impact of serum ferritin for survival in patients with relapsed or refractory metastatic colorectal cancer (mCRC). Methods: This retrospective cohort study reviewed clinicopathological characteristics and laboratory biomarkers in 120 mCRC patients being treated with Korean Medicine (KM). The overall survival (OS) of patients was calculated using the Kaplan-Meier method, and statistical significance was assessed using the log-rank test. Univariate and multivariate analyses of Cox proportional hazards regression were used to evaluate the prognostic impact for survival in relapsed or refractory mCRC patients. Results: Of the patients, 62.5% had liver metastases, 74.1% underwent greater than second-line chemotherapy, and 80.8% underwent surgery. Median OS was 7.6 months for all patients after the initiation of KM treatment, which was begun 13.7 months, on average, after mCRC diagnosis. Concerning prognostic factors such as the presence of liver metastasis (p = 0.024), high carcinoembryonic antigen level (CEA > 5 ng/mL, p = 0.044), elevated C-reactive protein (CRP ≥ 10.0 mg/L, p = 0.000), high absolute monocyte count (AMC > 413.3 cells/μL, p = 0.034), elevated serum ferritin (ferritin ≥ 150 ng/mL, p = 0.002), low hemoglobin level (Hb < 12 g/dL, p = 0.026) and low albumin (albumin < 3.5 g/dL, p = 0.003) were associated with increased hazard ratios and poor survival. According to the multivariate proportional hazards model with backward and forward manners, albumin (albumin < 3.5 g/dL; hazard ratio (HR) 2.218, 95% confidence interval (CI) 1.135 - 3.990, p = 0.019), CRP (CRP ≥ 10.0 mg/L; HR 2.506, 95% CI 1.644 - 3.822, p = 0.000), CEA (CEA > 5 ng/mL; HR 2.040, 95% CI 1.203 - 3.460, p = 0.008), and serum ferritin (ferritin ≥ 150 ng/mL; HR 1.763, 95% CI 1.169 - 2.660, p = 0.007) were independent prognostic biomarkers of survival in mCRC patients. Conclusions: These results indicate that serum ferritin acts as an independent prognostic biomarker for survival in relapsed or refractory mCRC patients.
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Affiliation(s)
- Sookyung Lee
- 1. Department of Clinical Oncology, College of Korean Medicine, Kyung Hee University
| | - Anna Song
- 2. Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Wankyu Eo
- 3. Department of Medical Oncology and Hematology, College of Medicine, Kyung Hee University
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Cao H, Wang C, Chai R, Dong Q, Tu S. Iron intake, serum iron indices and risk of colorectal adenomas: a meta-analysis of observational studies. Eur J Cancer Care (Engl) 2016; 26. [PMID: 26956572 DOI: 10.1111/ecc.12486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 11/29/2022]
Affiliation(s)
- H. Cao
- Department of Colorectal Surgery; Zhejiang Provincial People's Hospital; Hangzhou Zhejiang China
| | - C. Wang
- Department of Anus & Intestine surgery; The First People's Hospital of Fuyang District; Hangzhou Zhejiang China
| | - R. Chai
- Department of Colorectal Surgery; Zhejiang Provincial People's Hospital; Hangzhou Zhejiang China
| | - Q. Dong
- Department of Colorectal Surgery; Zhejiang Provincial People's Hospital; Hangzhou Zhejiang China
| | - S. Tu
- Department of Colorectal Surgery; Zhejiang Provincial People's Hospital; Hangzhou Zhejiang China
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Hung N, Shen CC, Hu YW, Hu LY, Yeh CM, Teng CJ, Kuan AS, Chen SC, Chen TJ, Liu CJ. Risk of cancer in patients with iron deficiency anemia: a nationwide population-based study. PLoS One 2015; 10:e0119647. [PMID: 25781632 PMCID: PMC4363660 DOI: 10.1371/journal.pone.0119647] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 02/02/2015] [Indexed: 12/20/2022] Open
Abstract
Objective This study evaluated the risk of cancer among patients with iron deficiency anemia (IDA) by using a nationwide population-based data set. Method Patients newly diagnosed with IDA and without antecedent cancer between 2000 and 2010 were recruited from the Taiwan National Health Insurance Research Database. The standardized incidence ratios (SIRs) of cancer types among patients with IDA were calculated. Results Patients with IDA exhibited an increased overall cancer risk (SIR: 2.15). Subgroup analysis showed that patients of both sexes and in all age groups had an increased SIR. After we excluded patients diagnosed with cancer within the first and first 5 years of IDA diagnosis, the SIRs remained significantly elevated at 1.43 and 1.30, respectively. In addition, the risks of pancreatic (SIR: 2.31), kidney (SIR: 2.23), liver (SIR: 1.94), and bladder cancers (SIR: 1.74) remained significantly increased after exclusion of patients diagnosed with cancer within 5 years after IDA diagnosis. Conclusion The overall cancer risk was significantly elevated among patients with IDA. After we excluded patients diagnosed with IDA and cancer within 1 and 5 years, the SIRs remained significantly elevated compared with those of the general population. The increased risk of cancer was not confined to gastrointestinal cancer when the SIRs of pancreatic, kidney, liver, and bladder cancers significantly increased after exclusion of patients diagnosed with IDA and cancer within the first 5 years. This finding may be caused by immune activities altered by IDA. Further study is necessary to determine the association between IDA and cancer risk.
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Affiliation(s)
- Ning Hung
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Che Shen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Yu-Wen Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of information magagement, National Chung-Cheng University, Chiayi, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Yu Hu
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Jen Teng
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ai-Seon Kuan
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - San-Chi Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
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Ruder EH, Berndt SI, Gilsing AMJ, Graubard BI, Burdett L, Hayes RB, Weissfeld JL, Ferrucci LM, Sinha R, Cross AJ. Dietary iron, iron homeostatic gene polymorphisms and the risk of advanced colorectal adenoma and cancer. Carcinogenesis 2014; 35:1276-83. [PMID: 24536049 DOI: 10.1093/carcin/bgu028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Dietary iron intake and variation in iron homeostasis genes may affect colorectal neoplasia risk. We conducted two nested case-control studies within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial: one of advanced colorectal adenoma (1205 cases; 1387 controls) and one of colorectal cancer (370 cases; 401 controls). Iron intake was estimated with a food frequency questionnaire and genotyping was performed for 21 genes. Unconditional logistic regression was used to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) for colorectal neoplasia risk within quartiles of intake. Several single nucleotide polymorphisms (SNPs) modified the association between iron intake and the risk of adenoma or cancer. Dietary iron was positively associated with colorectal adenoma among three SNPs of HEPHL1, including carriers of the AA genotype at rs7946162 (ORQ4-Q1 = 2.22, 95% CI 1.15-4.27, Ptrend = 0.03; Pinteraction = 0.10), the TT genotype at rs2460063 (ORQ4-Q1 = 2.39, 95% CI 1.26-4.54, Ptrend = 0.02; Pinteraction = 0.04) and the GG genotype at rs7127348 (ORQ4-Q1 = 2.40, 95% CI 1.23-4.67, Ptrend = 0.02; Pinteraction = 0.09). Heme iron was positively associated with colorectal cancer among those with GG genotypes for ACO1 rs10970985 (ORQ4-Q 1 = 2.45, 95% CI 3.40-8.06, Ptrend = 0.004; Pinteraction = 0.05). However, none of the associations were statistically significant after adjustment for multiple comparisons. Future studies should target the specific genes and SNPs for which the association was significant prior to multiple comparison correction.
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Affiliation(s)
- Elizabeth H Ruder
- School of Health and Rehabilitation Sciences, University of Pittsburgh, 4051 Forbes Tower, Pittsburgh, PA 15260, USA,
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Anne M J Gilsing
- Department of Epidemiology, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Laurie Burdett
- Core Genotyping Facility, National Cancer Institute, SAIC-Frederick, Inc., Gaithersburg, MD 20892, USA
| | - Richard B Hayes
- Division of Epidemiology, Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Joel L Weissfeld
- University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA 15232, USA and
| | | | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Amanda J Cross
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
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Sung MK, Bae YJ. Iron, Oxidative Stress, and Cancer. Cancer 2014. [DOI: 10.1016/b978-0-12-405205-5.00013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fonseca-Nunes A, Jakszyn P, Agudo A. Iron and Cancer Risk—A Systematic Review and Meta-analysis of the Epidemiological Evidence. Cancer Epidemiol Biomarkers Prev 2013; 23:12-31. [DOI: 10.1158/1055-9965.epi-13-0733] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Anic GM, Madden MH, Thompson RC, Nabors LB, Olson JJ, Larocca RV, Browning JE, Brockman JD, Forsyth PA, Egan KM. Toenail iron, genetic determinants of iron status, and the risk of glioma. Cancer Causes Control 2013; 24:2051-8. [PMID: 23996192 DOI: 10.1007/s10552-013-0281-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/21/2013] [Indexed: 01/10/2023]
Abstract
PURPOSE Iron is essential for oxygen transport and oxidative metabolism; however, elevated iron stores can trigger overproduction of reactive oxygen species and induce DNA damage. Little is known about the association between body iron stores and glioma risk. This study examined the associations of iron levels measured in toenails and genetic variants linked to body iron stores with risk of glioma in a clinic-based case-control study. METHODS Samples were collected a median of 24 days following glioma diagnosis in the cases (10th-90th percentile, range: 10-44 days). Nail iron levels were measured in 300 cases and 300 controls using neutron activation analysis. A total of 24 genetic variants associated with iron status were genotyped in 622 cases and 628 controls. Logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for glioma risk according to toenail iron and the examined genotypes. RESULTS No association was observed between toenail iron and glioma risk when restricting to cases with nails collected within ~3 weeks of diagnosis (OR = 0.93; 95 % CI 0.46, 1.87 comparing those with high (≥14 μg/g) vs. low (<6 μg/g) iron levels). In contrast, an inverse association with increasing iron was observed after restricting to cases with a delay of 3 weeks or greater (OR = 0.42; 95 % CI 0.19, 0.95), reflecting potentially insidious effects of advancing disease on iron levels among the cases. No associations were observed for any of the examined genetic variants. CONCLUSION The results do not support a role for body iron stores as a determinant of glioma risk.
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Affiliation(s)
- Gabriella M Anic
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA,
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Alkhateeb AA, Connor JR. The significance of ferritin in cancer: anti-oxidation, inflammation and tumorigenesis. Biochim Biophys Acta Rev Cancer 2013; 1836:245-54. [PMID: 23891969 DOI: 10.1016/j.bbcan.2013.07.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/09/2013] [Accepted: 07/18/2013] [Indexed: 12/16/2022]
Abstract
The iron storage protein ferritin has been continuously studied for over 70years and its function as the primary iron storage protein in cells is well established. Although the intracellular functions of ferritin are for the most part well-characterized, the significance of serum (extracellular) ferritin in human biology is poorly understood. Recently, several lines of evidence have demonstrated that ferritin is a multi-functional protein with possible roles in proliferation, angiogenesis, immunosuppression, and iron delivery. In the context of cancer, ferritin is detected at higher levels in the sera of many cancer patients, and the higher levels correlate with aggressive disease and poor clinical outcome. Furthermore, ferritin is highly expressed in tumor-associated macrophages which have been recently recognized as having critical roles in tumor progression and therapy resistance. These characteristics suggest ferritin could be an attractive target for cancer therapy because its down-regulation could disrupt the supportive tumor microenvironment, kill cancer cells, and increase sensitivity to chemotherapy. In this review, we provide an overview of the current knowledge on the function and regulation of ferritin. Moreover, we examine the literature on ferritin's contributions to tumor progression and therapy resistance, in addition to its therapeutic potential.
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Affiliation(s)
- Ahmed A Alkhateeb
- Department of Neurosurgery, The Pennsylvania State University Hershey Medical Center, Hershey, PA, USA
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Zhang X, Ma J, Wu K, Chan AT, Fuchs CS, Giovannucci EL. Blood donation and colorectal cancer incidence and mortality in men. PLoS One 2012; 7:e39319. [PMID: 22761761 PMCID: PMC3382220 DOI: 10.1371/journal.pone.0039319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/23/2012] [Indexed: 12/12/2022] Open
Abstract
Background Although blood donations may reduce body iron stores, to date, prospective data on frequent blood donation and colorectal cancer risk are limited. Methodology/Principal Findings We tested whether frequent blood donation is associated with a lower risk of colorectal cancer in the Health Professionals Follow-up Study. We prospectively followed 35,121men who provide the information on lifetime number of blood donations in 1992 through 2008. Serum ferritin levels were measured in a random sample of 305 men. Cox proportional hazard regression models were used to calculate the multivariable relative risks (RRs, 95%CIs) after adjusting for age and other established colorectal cancer risk factors. We documented 684 incident colorectal cancer cases and 224 deaths from colorectal cancer. The mean serum ferritin levels varied from 178 µg/L for men who did not donate blood to 98 µg/L for men who had at least 30 donations. Age-adjusted results for both incidence and mortality were essentially the same as the multivariable-adjusted results. Comparing with non-donors, the multivariable RRs (95%CIs) for colorectal cancer incidence were 0.92 (0.77, 1.11) for 1–5 donation, 0.85 (0.64, 1.11) for 6–9 donations, 0.96 (0.73, 1.26) for 10–19 donations, 0.91 (0.63, 1.32) for 20–29 donations, and 0.97 (0.68, 1.38) for at least 30 donations (Ptrend = 0.92). The multivariable RRs for colorectal cancer mortality were 0.99 (0.72, 1.36) for 1–5 donation, 0.93 (0.57, 1.51) for 6–9 donations, 0.85 (0.50, 1.42) for 10–19 donations, and 1.14 (0.72, 1.83) for at least 20 donations (Ptrend = 0.82). The results did not vary by cancer sub-sites, intake levels of total iron, heme iron, or family history of colorectal cancer. Conclusions/Significance Frequent blood donations were not associated with colorectal cancer incidence and mortality in men. Our results do not support an important role of body iron stores in colorectal carcinogenesis.
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Affiliation(s)
- Xuehong Zhang
- Channing Laboratory, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
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Abstract
BACKGROUND High iron levels can increase the formation of noxious oxygen radicals, which are thought to promote carcinogenesis. OBJECTIVE The aim of this prospective study was to determine whether iron biomarkers and HFE genotypes, which influence iron regulation, constitute risk factors for colorectal cancer. DESIGN This is a prospective nested case-referent study. SETTINGS The study was performed within the population-based Northern Sweden Health and Disease Study. PATIENTS The study included 226 cases of colorectal cancer and 437 matched referents. MAIN OUTCOME MEASURES Conditional regression analysis was performed. Adjustments for smoking, smoking and BMI, and HFE C282Y and H63D were performed. RESULTS The highest quintile of total iron-binding capacity showed significantly higher risk for colorectal cancer, unadjusted OR 2.35 (95% CI 1.38-4.02). When stratified by sex, the findings were only present in women (OR 3.34 (95% CI 1.59-7.02)). Ferritin was associated with reduced risk throughout quintiles 2 to 5 both in univariate and multivariate models. LIMITATIONS Colorectal cancer may influence iron markers because of occult bleeding. Homozygotes for HFE C282Y were too few to make conclusions for this group. The relatively short follow-up time might be insufficient to detect risk of iron biomarkers. CONCLUSIONS High iron levels do not increase the risk of colorectal cancer. HFE genotypes influencing iron uptake had no effect on colorectal cancer risk.
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Ellervik C, Tybjaerg-Hansen A, Nordestgaard BG. Risk of cancer by transferrin saturation levels and haemochromatosis genotype: population-based study and meta-analysis. J Intern Med 2012; 271:51-63. [PMID: 21605201 DOI: 10.1111/j.1365-2796.2011.02404.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Increased iron overload, whether or not owing to the presence of the haemochromatosis genotype C282Y/C282Y, may be associated with an increased risk of cancer. The aim of this study was to test the hypothesis that elevated transferrin saturation levels (as a proxy for iron overload) and haemochromatosis genotype C282Y/C282Y are associated with an increased risk of cancer. METHODS We conducted a population-based study of 8763 individuals, of whom 1417 developed a first cancer during 15years of follow-up, and a meta-analysis. We stratified absolute 10-year risk of cancer by smoking status, an important risk factor. RESULTS In women, transferrin saturation above 60% versus below 50% was associated with a hazard ratio of 3.6 (95% confidence interval (CI): 2.0-6.5; P<0.001) for any cancer; risk of liver cancer was increased in both women and men. In women, the corresponding absolute 10-year risk of any cancer was 34% and 30% in smokers and nonsmokers, respectively. In men, haemochromatosis genotype C282Y/C282Y versus wild type/wild type was associated with a hazard ratio of 3.7 (95% CI: 1.2-12; P=0.01) for any cancer, with a similar trend in women. In men, the corresponding absolute 10-year risk of cancer was 39% and 27% in smokers and nonsmokers, respectively. Other haemochromatosis genotypes were not associated with increased risk of cancer in women or men. From the meta-analysis, the odds ratio of any cancer for transferrin saturation ≥60% versus a reference group was 1.5 (95% CI: 1.2-1.8) for women and men combined. CONCLUSIONS We have demonstrated that elevated transferrin saturation levels in women and haemochromatosis genotype C282Y/C282Y in men are associated with increased risk of cancer. Thus, our results support the implementation of cancer screening programmes in patients with iron overload or with C282Y/C282Y.
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Affiliation(s)
- C Ellervik
- Department of Clinical Biochemistry, Herlev Hospital, Herlev Department of Clinical Biochemistry, Naestved Hospital, Naestved Copenhagen, Denmark
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Ferrucci LM, Sinha R, Huang WY, Berndt SI, Katki HA, Schoen RE, Hayes RB, Cross AJ. Meat consumption and the risk of incident distal colon and rectal adenoma. Br J Cancer 2011; 106:608-16. [PMID: 22166801 PMCID: PMC3281548 DOI: 10.1038/bjc.2011.549] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Most studies of meat and colorectal adenoma have investigated prevalent events from a single screening, thus limiting our understanding of the role of meat and meat-related exposures in early colorectal carcinogenesis. Methods: Among participants in the screening arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who underwent baseline and follow-up sigmoidoscopy (n=17 072), we identified 1008 individuals with incident distal colorectal adenoma. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations between meat and meat-related components and incident distal colorectal adenoma using multivariate logistic regression. Results: We observed suggestive positive associations for red meat, processed meat, haeme iron, and nitrate/nitrite with distal colorectal adenoma. Grilled meat (OR=1.56, 95% CI=1.04–2.36), well or very well-done meat (OR=1.59, 95% CI=1.05–2.43), 2-amino-1-methyl-6-phenyl-imidazo[4,5-b]pyridine (PhIP) (OR=1.75, 95% CI=1.17–2.64), benzo[a]pyrene (OR=1.53, 95% CI=1.06–2.20), and total mutagenic activity (OR=1.57, 95% CI=1.03–2.40) were positively associated with rectal adenoma. Total iron (diet and supplements) (OR=0.69, 95% CI=0.56–0.86) and iron from supplements (OR=0.65, 95% CI=0.44–0.97) were inversely associated with any distal colorectal adenoma. Conclusion: Our findings indicate that several meat-related components may be most relevant to early neoplasia in the rectum. In contrast, total iron and iron from supplements were inversely associated with any distal colorectal adenoma.
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Affiliation(s)
- L M Ferrucci
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Zhang X, Giovannucci EL, Smith-Warner SA, Wu K, Fuchs CS, Pollak M, Willett WC, Ma J. A prospective study of intakes of zinc and heme iron and colorectal cancer risk in men and women. Cancer Causes Control 2011; 22:1627-37. [PMID: 21909950 DOI: 10.1007/s10552-011-9839-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/27/2011] [Indexed: 01/10/2023]
Abstract
Although laboratory studies linked zinc and heme iron to colorectal cancer, epidemiologic evidence is limited. We prospectively examined these associations in the Nurses' Health Study and Health Professionals Follow-up Study. We used Cox proportional hazards regression analyses to calculate cohort-specific relative risks (RRs) and pooled results using a fixed-effects model. We documented 2,114 incident colorectal cancer cases during up to 22 years of follow-up. Compared highest to lowest quintile of dietary zinc intake, the pooled multivariable RRs (95% CIs) were 0.86 (0.73, 1.02) for colorectal cancer, 0.92 (0.76, 1.11) for colon cancer, and 0.68 (0.47, 0.99) for rectal cancer. The significant inverse association between dietary zinc intake and risk of rectal cancer was mainly driven by data in women, although the difference in the sex-specific results was not statistically significant. For the same comparison, the pooled multivariable RRs (95% CIs) for heme iron were 1.10 (0.93, 1.30) for colorectal cancer, 1.06 (0.88, 1.29) for colon cancer, and 1.20 (0.83, 1.75) for rectal cancer. These associations were not significantly modified by alcohol consumption, body mass index, physical activity, menopausal status, or postmenopausal hormone use. Total zinc intake, total iron intake, dietary iron intake, and zinc or iron supplement uses were largely not associated with colorectal cancer risk. Our study does not support strong roles of zinc and heme iron intake in colorectal cancer risk; however, a suggestive inverse association of dietary zinc intake with rectal cancer risk in women requires further study.
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Affiliation(s)
- Xuehong Zhang
- Channing Laboratory at Landmark Center (West Wing), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 401 Park Drive, Boston, MA 02115, USA.
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Cross AJ, Sinha R, Wood RJ, Xue X, Huang WY, Yeager M, Hayes RB, Gunter MJ. Iron homeostasis and distal colorectal adenoma risk in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Prev Res (Phila) 2011; 4:1465-75. [PMID: 21685236 DOI: 10.1158/1940-6207.capr-11-0103] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Red meat consumption has been positively associated with colorectal cancer; however, the biological mechanism underlying this relationship is not understood. Red meat is a major source of iron, which may play a role in colorectal carcinogenesis via increased crypt cell proliferation, cytotoxicity, and endogenous N-nitrosation. In a nested case-control study within the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, we prospectively evaluated multiple iron exposure parameters, including dietary intake and serum measures of iron, ferritin, transferrin, total iron binding capacity (TIBC), and unsaturated iron binding capacity (UIBC) in relation to incident colorectal adenoma in 356 cases and 396 matched polyp-free controls. We also investigated variation in eight key genes involved in iron homeostasis in relation to colorectal adenoma in an additional series totaling 1,126 cases and 1,173 matched controls. We observed a positive association between red meat intake and colorectal adenoma [OR comparing extreme quartiles (OR(q4-q1)) = 1.59, 95% CI = 1.02-2.49, P(trend) = 0.03]. Serum TIBC and UIBC were inversely associated with colorectal adenoma (OR(q4-q1) = 0.57, 95% CI = 0.37-0.88, P(trend) = 0.03; and OR(q4-q1) = 0.62, 95% CI = 0.40-0.95, P(trend) = 0.04, respectively). Colorectal adenoma was not associated with serum ferritin, iron, or transferrin saturation or with polymorphisms in genes involved in iron homeostasis. Serum TIBC and UIBC, parameters that have a reciprocal relationship with overall iron load, were inversely related to colorectal adenoma, suggesting that individuals with lower iron status have a reduced risk of developing colorectal adenoma.
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Affiliation(s)
- Amanda J Cross
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Rockville, MD 20852, USA.
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29
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Abstract
As one of the most prevalent cancers, prostate cancer has enormous public health significance and prevention strategies would attenuate its economic, emotional, physical and social impact. Until recently, however, we have had only modest information about risk factors for this disease, apart from the well-established characteristics of age, family history and place of birth. The large worldwide variation in the incidence of prostate cancer and the increased risk in migrants who move from low-risk to high-risk countries provide strong support for modifiable environmental factors, particularly diet, in its etiology. Thus, dietary agents have gained considerable attention as chemopreventive agents against prostate cancer. Dietary fat, red and processed meat, vitamin E, selenium, tomatoes, cruciforms and green tea have all been linked with the development and aggressiveness of prostate cancer, through a range of molecular mechanisms. The direction of future clinical trials lies in clarifying the effects of these agents and exploring the biological mechanisms responsible for the prevention of prostate cancer. However, owing to the short time period between diagnosis and treatment, conventional dietary intervention techniques are not always realistic. Until large randomized trials confirm the benefit of chemopreventive and dietary modifications, patients can be advised to pursue a diet and lifestyle that enhances overall health.
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30
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Osborne NJ, Gurrin LC, Allen KJ, Constantine CC, Delatycki MB, McLaren CE, Gertig DM, Anderson GJ, Southey MC, Olynyk JK, Powell LW, Hopper JL, Giles GG, English DR. HFE C282Y homozygotes are at increased risk of breast and colorectal cancer. Hepatology 2010; 51:1311-8. [PMID: 20099304 PMCID: PMC3815603 DOI: 10.1002/hep.23448] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
UNLABELLED The evidence that mutations in the HFE gene for hemochromatosis are associated with increased cancer risk is inconsistent. The Melbourne Collaborative Cohort Study is a prospective cohort study that commenced recruitment in 1990. Participants born in Australia, New Zealand, the United Kingdom, or Ireland (n = 28,509) were genotyped for the HFE C282Y (substitution of tyrosine for cysteine at amino acid 282) variant. Incident cancers were ascertained from Australian cancer registries during an average of 14 years follow-up. Hazard ratios (HRs), confidence intervals (CIs), and P values were obtained from separate Cox regression analyses for colorectal, breast, and prostate cancers, all other solid cancers, and all cancers. Compared to those with no C282Y variant, C282Y homozygotes were at increased risk of colorectal cancer (HR = 2.28; 95% CI = 1.22, 4.25; P = 0.01) and female C282Y homozygotes were at increased risk of developing breast cancer (HR = 2.39; 95% CI = 1.24, 4.61; P = 0.01), but male C282Y homozygotes were not at increased risk for prostate cancer (HR = 0.96; 95% CI = 0.43, 2.15; P = 0.92). C282Y/H63D compound heterozygotes were not at increased risk for colorectal cancer (HR = 1.27; 95% CI = 0.80, 2.01), breast cancer (HR = 1.16; 95% CI = 0.74, 1.84), or prostate cancer (HR = 1.08; 95% CI = 0.68, 1.70). CONCLUSION HFE C282Y homozygotes have twice the risk of colorectal and breast cancer compared with those individuals without the C282Y variant.
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Affiliation(s)
- Nicholas J. Osborne
- Gut and Liver, Murdoch Childrens Research Institute, Melbourne, VIC Australia,Centre for MEGA Epidemiology, University of Melbourne, Melbourne, VIC, Australia,Department of Paediatrics, the University of Melbourne, Melbourne, VIC, Australia
| | - Lyle C Gurrin
- Gut and Liver, Murdoch Childrens Research Institute, Melbourne, VIC Australia,Centre for MEGA Epidemiology, University of Melbourne, Melbourne, VIC, Australia
| | - Katrina J. Allen
- Gut and Liver, Murdoch Childrens Research Institute, Melbourne, VIC Australia,Department of Paediatrics, the University of Melbourne, Melbourne, VIC, Australia,Department of Gastroenterology, The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Clare C Constantine
- Centre for MEGA Epidemiology, University of Melbourne, Melbourne, VIC, Australia
| | - Martin B. Delatycki
- Department of Paediatrics, the University of Melbourne, Melbourne, VIC, Australia,Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | | | - Dorota M Gertig
- Centre for MEGA Epidemiology, University of Melbourne, Melbourne, VIC, Australia,Victorian Cervical Cytology Registry, Melbourne, VIC, Australia
| | | | - Melissa C Southey
- Department of Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - John K Olynyk
- Department of Gastroenterology, Fremantle Hospital, Fremantle, WA, Australia,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia,Western Australian Institute of Medical Research, Perth
| | - Lawrie W. Powell
- Queensland Institute of Medical Research, Brisbane QLD, Australia,University of Queensland, Brisbane QLD, Australia
| | - John L Hopper
- Centre for MEGA Epidemiology, University of Melbourne, Melbourne, VIC, Australia
| | - Graham G Giles
- Centre for MEGA Epidemiology, University of Melbourne, Melbourne, VIC, Australia,Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, VIC Australia
| | - Dallas R English
- Centre for MEGA Epidemiology, University of Melbourne, Melbourne, VIC, Australia,Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, VIC Australia
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Hori A, Mizoue T, Kasai H, Kawai K, Matsushita Y, Nanri A, Sato M, Ohta M. Body iron store as a predictor of oxidative DNA damage in healthy men and women. Cancer Sci 2010; 101:517-22. [PMID: 19895603 PMCID: PMC11158582 DOI: 10.1111/j.1349-7006.2009.01394.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
While iron plays an important role in many cellular functions, excess iron storage induces DNA damage by generating hydroxyl radicals and thus promotes carcinogenesis. However, it remains unclear whether body iron levels that are commonly observed in a general population are related to oxidative DNA damage. We examined the association between serum ferritin concentrations and levels of urinary 8-hydroxydeoxyguanosine (8-OHdG), a biomarker of systemic oxidative DNA damage and repair, in 528 Japanese men and women aged 21-67 years. Men had much higher ferritin levels than in women, and the levels were significantly greater in women aged 50 years or older than in women aged less than 50 years. Urinary 8-OHdG concentrations were significantly and positively associated with serum ferritin levels in all the subgroups. The Spearman rank correlation coefficients were 0.47, 0.76, and 0.73 for men overall, women aged less than 50 years, and women aged 50 years or older, respectively. These associations were materially unchanged after adjustment for potential confounding variables. In men, a more pronounced association was observed in nonsmokers than in smokers. Our results suggest body iron storage is a strong determinant of levels of systemic oxidative DNA damage in a healthy population.
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Affiliation(s)
- Ai Hori
- Department of Epidemiology and International Health, Research Institute, International Medical Center of Japan, Tokyo, Japan
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Prá D, Rech Franke SI, Pegas Henriques JA, Fenech M. A possible link between iron deficiency and gastrointestinal carcinogenesis. Nutr Cancer 2009; 61:415-26. [PMID: 19838913 DOI: 10.1080/01635580902803701] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is definitive evidence that iron overload induces oxidative stress and DNA damage, which can enhance carcinogenic risk. However, other evidence suggests that iron deficiency and anemia also increase oxidative stress and DNA damage, which might increase carcinogenesis risk, especially in the gastrointestinal (GI) tract. The aim of this review is to provide essential background information for the accurate interpretation of future research on iron deficiency and increased GI cancer risk. Based on clinical, epidemiological, and experimental evidence, we discuss how iron deficiency might contribute to increased cancer risk through the impairment of several iron-dependent metabolic functions that are related to genome protection and maintenance (e.g., immune responses against cancer-initiated cells, metabolism of toxic compounds, and redox regulation of DNA biosynthesis and repair). Some epidemiological studies have indicated increased risk of GI tumors among individuals with low iron intake or low somatic iron stores, and in vivo data from rodent cancer models indicates the early progression of GI tumors during iron deficiency. Given the preliminary but consistent evidence relating iron deficiency to cancer risk and the fact that iron deficiency affects about one third of the world's population, further studies are needed to define the extent to which iron deficiency might increase GI cancer risk.
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Affiliation(s)
- Daniel Prá
- Universidade Católica de Pelotas, Pelotas, RS, Brasil.
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33
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Sinha R, Park Y, Graubard BI, Leitzmann MF, Hollenbeck A, Schatzkin A, Cross AJ. Meat and meat-related compounds and risk of prostate cancer in a large prospective cohort study in the United States. Am J Epidemiol 2009; 170:1165-77. [PMID: 19808637 DOI: 10.1093/aje/kwp280] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The authors examined associations between meat consumption (type, cooking method, and related mutagens), heme iron, nitrite/nitrate, and prostate cancer in a cohort of 175,343 US men aged 50-71 years. During 9 years of follow-up (1995-2003), they ascertained 10,313 prostate cancer cases (1,102 advanced) and 419 fatal cases. Hazard ratios comparing the fifth intake quintile with the first revealed elevated risks associated with red and processed meat for total (red meat: hazard ratio (HR) = 1.12, 95% confidence interval (CI): 1.04, 1.21; processed meat: HR = 1.07, 95% CI: 1.00, 1.14) and advanced (red meat: HR = 1.31, 95% CI: 1.05, 1.65; processed meat: HR = 1.32, 95% CI: 1.08, 1.61) prostate cancer. Heme iron, barbecued/grilled meat, and benzo[a]pyrene were all positively associated with total (HR = 1.09 (95% CI: 1.02, 1.17), HR = 1.11 (95% CI: 1.03, 1.19), and HR = 1.09 (95% CI: 1.00, 1.18), respectively) and advanced (HR = 1.28 (95% CI: 1.03, 1.58), HR = 1.36 (95% CI: 1.10, 1.69), and HR = 1.28 (95% CI: 1.00, 1.65), respectively) disease. Nitrite (HR = 1.24, 95% CI: 1.02, 1.51) and nitrate (HR = 1.31, 95% CI: 1.07, 1.61) intakes were associated with advanced prostate cancer. There were no clear associations for fatal prostate cancer. Red and processed meat may be positively associated with prostate cancer via mechanisms involving heme iron, nitrite/nitrate, grilling/barbecuing, and benzo[a]pyrene.
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Affiliation(s)
- Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892, USA
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34
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Ferrucci LM, Sinha R, Graubard BI, Mayne ST, Ma X, Schatzkin A, Schoenfeld PS, Cash BD, Flood A, Cross AJ. Dietary meat intake in relation to colorectal adenoma in asymptomatic women. Am J Gastroenterol 2009; 104:1231-40. [PMID: 19367270 PMCID: PMC2891034 DOI: 10.1038/ajg.2009.102] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES No previous study has concurrently assessed the associations between meat intake, meat-cooking methods and doneness levels, meat mutagens (heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons), heme iron, and nitrite from meat and colorectal adenoma in asymptomatic women undergoing colonoscopy. METHODS Of the 807 eligible women in a cross-sectional multicenter colonoscopy screening study, 158 prevalent colorectal adenoma cases and 649 controls satisfactorily completed the validated food frequency and meat questionnaires. Using an established meat mutagen database and new heme iron and nitrite databases, we comprehensively investigated the components of meat that may be involved in carcinogenesis. Using logistic regression, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) within quartiles of meat-related variables. RESULTS Red meat was associated positively with colorectal adenoma (OR fourth vs. first quartile = 2.02; 95% CI = 1.06-3.83; P trend = 0.38). Intake of pan-fried meat (OR = 1.72; 95% CI = 0.96-3.07; P trend = 0.01) and the HCA: 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) (OR = 1.90; 95% CI = 1.05-3.42; P trend = 0.07) were also associated with an increased risk of colorectal adenoma. The new databases yielded lower estimates of heme iron and nitrite than previous assessment methods, although the two methods were highly correlated for both exposures. Although not statistically significant, there were positive associations between iron and heme iron from meat and colorectal adenoma. CONCLUSIONS In asymptomatic women undergoing colonoscopy, colorectal adenomas were associated with high intake of red meat, pan-fried meat, and the HCA MeIQx. Other meat-related exposures require further investigation.
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Affiliation(s)
- Leah M. Ferrucci
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Susan T. Mayne
- Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT
| | - Xiaomei Ma
- Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT
| | - Arthur Schatzkin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Philip S. Schoenfeld
- Division of Gastroenterology, University of Michigan School of Medicine and Veterans Affairs Center for Excellence in Health Services Research, Ann Arbor, MI,Division of Gastroenterology, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Brooks D. Cash
- Division of Gastroenterology, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Andrew Flood
- Division of Epidemiology and Community Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Amanda J. Cross
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
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Klenow S, Pool-Zobel BL, Glei M. Influence of inorganic and organic iron compounds on parameters of cell growth and survival in human colon cells. Toxicol In Vitro 2009; 23:400-7. [DOI: 10.1016/j.tiv.2009.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Corley DA, Kubo A, Levin TR, Habel L, Zhao W, Leighton P, Rumore G, Quesenberry C, Buffler P, Block G. Iron intake and body iron stores as risk factors for Barrett's esophagus: a community-based study. Am J Gastroenterol 2008; 103:2997-3004. [PMID: 18853987 PMCID: PMC2671068 DOI: 10.1111/j.1572-0241.2008.02156.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE High iron stores are a proposed modifiable risk factor for esophageal adenocarcinoma, but minimal human data exist. We evaluated whether iron intake and iron stores were associated with Barrett's esophagus, a metaplastic change that is a strong risk factor for esophageal adenocarcinoma. METHODS We conducted a case-control study within the Kaiser Permanente Northern California population. We identified all persons with a new diagnosis of Barrett's esophagus (cases); they were matched to persons with GERD (without Barrett's esophagus) and to population controls. Subjects completed examinations, dietary questionnaires, and testing for serum iron stores (ferritin and transferrin saturation). Analyses used unconditional logistic regression. RESULTS We evaluated 319 cases, 312 GERD patients, and 313 population controls. Compared with population controls, Barrett's esophagus patients had lower dietary iron intakes (4th vs 1st quartiles, odds ratio [OR]= 0.37, 95% confidence interval [CI] 0.17-0.80), similar total iron intakes (including supplement use), and lower iron stores (4th vs 1st quartiles, ferritin OR = 0.24, 95% CI 0.14-0.40;% transferrin saturation OR = 0.66, 95% CI 0.41-1.04; P value trend <0.01 and 0.03, respectively). Similar associations were observed in comparisons with GERD controls and among subjects without clear sources of blood loss on endoscopy. CONCLUSIONS Patients with Barrett's esophagus had lower dietary iron intakes and lower serum iron stores than controls in our population. These findings do not provide support for the current hypothesis that high iron stores or a high iron intake are risk factors for Barrett's esophagus, a potential early event in the carcinogenic sequence for esophageal adenocarcinoma.
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Affiliation(s)
- Douglas A Corley
- Division of Research, Kaiser Permanente, Oakland, California 94612, USA
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37
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Choi JY, Neuhouser ML, Barnett MJ, Hong CC, Kristal AR, Thornquist MD, King IB, Goodman GE, Ambrosone CB. Iron intake, oxidative stress-related genes (MnSOD and MPO) and prostate cancer risk in CARET cohort. Carcinogenesis 2008; 29:964-70. [PMID: 18296681 DOI: 10.1093/carcin/bgn056] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Iron overload may increase prostate cancer risk through stimulation of oxidative stress, and endogenous pro- and antioxidant capabilities, i.e. manganese superoxide dismutase (MnSOD) and myeloperoxidase (MPO), may modify these associations. We investigated this hypothesis in the Carotene and Retinol Efficacy Trial cohort in a nested case-control study. Although there was no association between iron intake and risk overall, there was a suggestion of increased risk of clinically aggressive prostate cancer with higher iron intake [odds ratio (OR) = 1.4, 95% confidence interval (CI) = 0.9-2.0]. Associations were most notable for men with aggressive prostate cancer who were below the median consumption of total fruits and vegetables (OR = 1.8, 95% CI = 1.1-3.2). Associations between MPO -463 G to A genotype (rs2333227) and prostate cancer risk were only noted among men with aggressive cancer, with more than a 2-fold risk reduction among men with AA genotypes (OR = 0.4, 95% CI = 0.2-1.0); MnSOD was not associated with risk overall, but the MnSOD T to C (Val-9Ala, rs4880) polymorphism modified associations between risk of clinically aggressive prostate cancer and dietary iron intake (P for interaction = 0.02). Among aggressive cancer cases with the TT genotype, higher iron intake level was associated with >2-fold increase in risk (OR = 2.3, 95% CI = 1.0-4.9), whereas there was no association among men with CC genotypes (OR = 0.9, 95% CI = 0.4-2.3). Although interactions were not significant, there were similar patterns for MPO genotype, iron intake and risk. These findings suggest that higher iron intake may be associated with risk of clinically aggressive prostate cancer, and that endogenous antioxidant capabilities may modify these associations.
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Affiliation(s)
- Ji-Yeob Choi
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA
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Gurusamy K, Davidson BR. Trace element concentration in metastatic liver disease: a systematic review. J Trace Elem Med Biol 2007; 21:169-77. [PMID: 17697955 DOI: 10.1016/j.jtemb.2007.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 03/16/2007] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are conflicting reports about the levels of trace elements in secondary liver cancers. This review summarises the evidence associating secondary liver tumours with trace elements. METHODS MEDLINE, EMBASE and CENTRAL databases were searched for the period up to January 2006 using a formal search strategy. Various inclusion and exclusion criteria were applied to select the articles for inclusion. Data extraction was performed using a custom designed data extraction form. RESULTS A total of 6917 references were identified. About 1359 duplicates were excluded using EndNote. About 5529 clearly irrelevant references were excluded through reading titles and abstracts. Of these 24 references were excluded by applying the exclusion criteria. Five studies including 239 patients and measuring iron content (2), copper content (4) and zinc (3) qualified for the review. Both studies on iron, three studies on copper and all the studies on zinc used quantitative methods to determine mineral content. A meta-analysis was performed using the random effects model. CONCLUSION Copper and zinc content are lower in secondary liver cancer compared to livers from healthy patients. Iron, copper and zinc content are lower in liver secondaries compared to the normal tissues surrounding the secondaries. Reasons and implications for the trace element alterations should be further investigated.
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Affiliation(s)
- K Gurusamy
- Department of HPB and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, UCL and Royal Free Hospital NHS Trust, London, UK.
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39
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Knöbel Y, Weise A, Glei M, Sendt W, Claussen U, Pool-Zobel BL. Ferric iron is genotoxic in non-transformed and preneoplastic human colon cells. Food Chem Toxicol 2006; 45:804-11. [PMID: 17157427 DOI: 10.1016/j.fct.2006.10.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 10/09/2006] [Accepted: 10/30/2006] [Indexed: 01/13/2023]
Abstract
Iron could be a relevant risk factor for carcinogenesis since it catalyses the formation of reactive oxygen species (ROS), which damage DNA. We previously demonstrated genotoxic effects by ferric iron using the human colon cancer cell line HT29. Here we investigated ferric iron in primary non-transformed colon cells and in a preneoplastic colon adenoma cell line (LT97), which both are suitable models to study effects of carcinogens during early stages of cell transformation. Genetic damage was determined using the Comet assay. Comet FISH (fluorescence in situ hybridization) was used to assess specific effects on TP53. Fe-NTA (0-1000 microM, 30 min, 37 degrees C) significantly induced single strand breaks in primary colon cells (500 microM Fe-NTA: Tail intensity [TI] 22.6%+/-5.0% versus RPMI control: TI 10.6%+/-3.9%, p<0.01) and in LT97 cells (1000 microM Fe-NTA: TI 26.8%+/-7.3% versus RPMI control: TI 11.1%+/-3.7%, p<0.01). With the Comet FISH protocol lower concentrations of Fe-NTA significantly increased DNA damage already at 100 and 250 microM Fe-NTA in primary colon and LT97 adenoma cells, respectively. This damage was detected as an enhanced migration of TP53 signals into the comet tail in both cell types, which indicates a high susceptibility of this tumor relevant gene towards Fe-NTA. In conclusion, Fe-NTA acts genotoxic in non-transformed and in preneoplastic human colon cells, in which it also enhances migration of TP53 at relatively low concentrations. Translated to the in vivo situation these results suggest that iron overload putatively contributes to a genotoxic risk during early stages of colorectal carcinogenesis on account of its genotoxic potential in non-tumorigenic human colon cells.
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Affiliation(s)
- Y Knöbel
- Institute of Nutrition, Department of Nutritional Toxicology, Friedrich-Schiller-University, Dornburger Str. 25, 07743 Jena, Germany
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