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Liang J, Huang Y, Yin L, Sadeghi F, Yang Y, Xiao X, Adami HO, Ye W, Zhang Z, Fang F. Cancer risk following surgical removal of tonsils and adenoids - a population-based, sibling-controlled cohort study in Sweden. BMC Med 2023; 21:194. [PMID: 37226237 DOI: 10.1186/s12916-023-02902-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Removal of tonsils and adenoids is among the most common surgical procedures worldwide. Evidence of increased risk of cancer following such surgery is, however, inconclusive. METHODS We conducted a population-based, sibling-controlled cohort study of 4,953,583 individuals in Sweden with a follow-up during 1980-2016. History of tonsillectomy, adenotonsillectomy, and adenoidectomy was identified from the Swedish Patient Register whereas incident cases of cancer during follow-up were identified from the Swedish Cancer Register. We used Cox models to calculate hazard ratios (HR) with 95% confidence intervals (CI) of cancer in both a population and a sibling comparison. The sibling comparison was used to assess the potential impact of familial confounding, due to shared genetic or non-genetic factors within a family. RESULTS We found a modestly increased risk for any cancer following tonsillectomy, adenoidectomy, or adenotonsillectomy in both the population (HR 1.10; 95%CI 1.07-1.12) and sibling (HR 1.15; 95%CI 1.10-1.20) comparisons. The association did not differ greatly by type of surgery, age at surgery, or potential indication for surgery, and persisted more than two decades after surgery. An excess risk was consistently observed for cancer of the breast, prostate, thyroid, and for lymphoma in both population and sibling comparisons. A positive association was observed for pancreatic cancer, kidney cancer, and leukemia in the population comparison whereas a positive association was observed for esophageal cancer in the sibling comparison. CONCLUSIONS Surgical removal of tonsils and adenoids is associated with a modestly increased risk of cancer during the decades following the surgery. The association is unlikely attributed to confounding due to shared genetic or non-genetic factors with a family.
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Affiliation(s)
- Jinfeng Liang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor (Guangxi Medical University), Ministry of Education, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning, Guangxi, China
| | - Yi Huang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor (Guangxi Medical University), Ministry of Education, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fatemeh Sadeghi
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yanping Yang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor (Guangxi Medical University), Ministry of Education, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning, Guangxi, China
| | - Xue Xiao
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor (Guangxi Medical University), Ministry of Education, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning, Guangxi, China
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zhe Zhang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China.
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Kacimi SEO, Elgenidy A, Cheema HA, Ould Setti M, Khosla AA, Benmelouka AY, Aloulou M, Djebabria K, Shamseldin LS, Riffi O, Mesli NS, Sekkal HZ, Afifi AM, Shah J, Ghozy S. Prior Tonsillectomy and the Risk of Breast Cancer in Females: A Systematic Review and Meta-analysis. Front Oncol 2022; 12:925596. [PMID: 35936707 PMCID: PMC9350012 DOI: 10.3389/fonc.2022.925596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Exposure to recurrent infections in childhood was linked to an increased risk of cancer in adulthood. There is also evidence that a history of tonsillectomy, a procedure often performed in children with recurrent infections, is linked to an increased risk of leukemia and Hodgkin lymphoma. Tonsillectomy could be directly associated with cancer risk, or it could be a proxy for another risk factor such as recurrent infections and chronic inflammation. Nevertheless, the role of recurrent childhood infections and tonsillectomy on the one hand, and the risk of breast cancer (BC) in adulthood remain understudied. Our study aims to verify whether a history of tonsillectomy increases the risk of BC in women. Methods A systematic review was performed using PubMed, Google Scholar, Scopus, Embase, and Web of Science databases from inception to January 25, 2022, to identify the studies which assessed the association between the history of tonsillectomy and BC in females. Odds ratio (OR) was calculated using the random/fixed-effects models to synthesize the associations between tonsillectomy and BC risk based on heterogeneity. Results Eight studies included 2252 patients with breast cancer of which 1151 underwent tonsillectomy and 5314 controls of which 1725 had their tonsils removed. Patients with a history of tonsillectomy showed a higher subsequent risk of developing BC (OR, 1.24; 95% CI: 1.11-1.39) as compared to patients without a history of tonsillectomy. Influence analyses showed that no single study had a significant effect on the overall estimate or the heterogeneity. Conclusions Our study revealed that a history of tonsillectomy is associated with an increased risk of breast cancer. These findings underscore the need for frequent follow-ups and screening of tonsillectomy patients to assess for the risk of BC.
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Affiliation(s)
| | | | | | - Mounir Ould Setti
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Global Database Studies, IQVIA, Espoo, Finland
| | | | | | - Mohammad Aloulou
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
- *Correspondence: Mohammad Aloulou, ; Sherief Ghozy, , orcid.org/0000-0001-5629-3023
| | | | | | - Omar Riffi
- Faculty of Medicine, Abou-Bekr Belkaid University of Tlemcen, Tlemcen, Algeria
| | - Nabil Smain Mesli
- Faculty of Medicine, Abou-Bekr Belkaid University of Tlemcen, Tlemcen, Algeria
- Department of Surgery A, University-Hospital Center (CHU) of Tlemcen, Tlemcen, Algeria
| | - Hanane Z. Sekkal
- Faculty of Medicine, Abou-Bekr Belkaid University of Tlemcen, Tlemcen, Algeria
| | - Ahmed M. Afifi
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, United States
| | - Jaffer Shah
- New York State Department of Health, Albany, NY, United States
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program), Oxford University, Oxford, United Kingdom
- *Correspondence: Mohammad Aloulou, ; Sherief Ghozy, , orcid.org/0000-0001-5629-3023
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Tonsillectomy and the incidence of various types of cancer. Immunol Res 2021; 69:467-470. [PMID: 34523058 PMCID: PMC8580919 DOI: 10.1007/s12026-021-09230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/28/2021] [Indexed: 11/03/2022]
Abstract
A potential connection between tonsillectomy and the development of various cancer types has repeatedly been reported in the scientific literature, but many studies have contradicted these observations. Thus, we have no clear evidence, neither to firmly support nor to refute the above-mentioned connection. Here, I suggest that the main reason for the lack of clearer evidence is that the investigations have so far mainly used incorrect sample groups. I propose that individual differences in the tonsils' involvement in immune reactions should be taken into account to solve this long-standing puzzle.
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Sauer S, Beinart D, Finn SMB, Kumar SL, Cheng Q, Hwang SE, Parker W, Devi GR. Hymenolepis diminuta-based helminth therapy in C3(1)-TAg mice does not alter breast tumor onset or progression. EVOLUTION MEDICINE AND PUBLIC HEALTH 2021; 9:131-138. [PMID: 33738103 PMCID: PMC7953836 DOI: 10.1093/emph/eoab007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 02/07/2021] [Indexed: 12/28/2022]
Abstract
Background and objectives An individual's risk of breast cancer is profoundly affected by evolutionary mismatch. Mismatches in Western society known to increase the risk of breast cancer include a sedentary lifestyle and reproductive factors. Biota alteration, characterized by a loss of biodiversity from the ecosystem of the human body as a result of Western society, is a mismatch known to increase the risk of a variety of inflammation-related diseases, including colitis-associated colon cancer. However, the effect of biota alteration on breast cancer has not been evaluated. Methodology In this study, we utilized the C3(1)-TAg mouse model of breast cancer to evaluate the role of biota alteration in the development of breast cancer. This model has been used to recapitulate the role of exercise and pregnancy in reducing the risk of breast cancer. C3(1)-TAg mice were treated with Hymenolepis diminuta, a benign helminth that has been shown to reverse the effects of biota alteration in animal models. Results No effect of the helminth H. diminuta was observed. Neither the latency nor tumor growth was affected by the therapy, and no significant effects on tumor transcriptome were observed based on RNAseq analysis. Conclusions and implications These findings suggest that biota alteration, although known to affect a variety of Western-associated diseases, might not be a significant factor in the high rate of breast cancer observed in Western societies. Lay summary An almost complete loss of intestinal worms in high-income countries has led to increases in allergic disorders, autoimmune conditions, and perhaps colon cancer. However, in this study, results using laboratory mice suggest that loss of intestinal worms might not be associated with breast cancer.
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Affiliation(s)
- Scott Sauer
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Dylan Beinart
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Sade M B Finn
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Sereena L Kumar
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Qing Cheng
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Shelley E Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - William Parker
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Gayathri R Devi
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Gakis G, Hassan FN, Schmid MA, Ölschläger M, Hackenberg S, Stenzl A, Renninger M. Prognostic significance of previous tonsillectomy after radical cystectomy for bladder cancer. Scand J Urol 2020; 54:297-303. [PMID: 32500778 DOI: 10.1080/21681805.2020.1773530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: To examine whether previous tonsillectomy (TE) impacts on survival after radical cystectomy (RC) for bladder cancer (BC).Patients and Methods: A total of 320 patients were staged cM0 and underwent RC for BC between 2002 and 2013. We retrospectively investigated whether patients had undergone TE prior to RC. Chi-square/Fisher-Exact test was carried out to compare clinicopathological features between the TE- and non-TE-group. Kaplan-Meier analysis with log-rank test was used to estimate recurrence-free survival (RFS) and multivariable Cox-regression analysis of risk factors of recurrence. The median follow-up was 31 months (interquartile range: 9-54).Results: A history of TE was present in 18 of the 320 patients (5.6%). All TEs were performed for benign conditions. TE prior to RC was associated with a history of appendectomy (p = 0.045), lower age at RC (p = 0.029), tumor unifocality (p < 0.001), advanced histopathological tumor stage (p = 0.015), non-pure urothelial carcinoma (p = 0.025), lymphovascular invasion (p = 0.035) and receipt of palliative chemotherapy (p = 0.004). The 3-year RFS was 39.2% for patients with previous TE and 62.4% for those without (p = 0.008). In multivariable analysis, adjusted for all significant parameters of univariable analysis, lymph-node tumor involvement (p = 0.017), positive surgical margins (p = 0.047), tumor grade (p = 0.032), advanced tumor stage (≥pT3a; p = 0.049) and a history of TE (p = 0.021) remained independent prognosticators of recurrence.Conclusion: In this series, previous TE was an independent predictor of recurrence after RC for BC. Further studies are needed to assess whether TE induces immunological alterations that might exert adverse effects on cancer progression of patients with invasive BC.
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Affiliation(s)
- Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius-Maximilians University, Wuerzburg, Germany.,Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius-Maximilians University, Wuerzburg, Germany.,Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
| | - Manuel Alexander Schmid
- Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
| | - Markus Ölschläger
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Stephan Hackenberg
- Department of ENT, University Hospital of Würzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
| | - Markus Renninger
- Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
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Byars SG, Stearns SC, Boomsma JJ. Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood. JAMA Otolaryngol Head Neck Surg 2019; 144:594-603. [PMID: 29879264 DOI: 10.1001/jamaoto.2018.0614] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Surgical removal of adenoids and tonsils to treat obstructed breathing or recurrent middle-ear infections remain common pediatric procedures; however, little is known about their long-term health consequences despite the fact that these lymphatic organs play important roles in the development and function of the immune system. Objective To estimate long-term disease risks associated with adenoidectomy, tonsillectomy, and adenotonsillectomy in childhood. Design, Setting, and Participants A population-based cohort study of up to 1 189 061 children born in Denmark between 1979 and 1999 and evaluated in linked national registers up to 2009, covering at least the first 10 and up to 30 years of their life, was carried out. Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery. Exposures Participants were classified as exposed if adenoids or tonsils were removed within the first 9 years of life. Main Outcomes and Measures The incidence of disease (defined by International Classification of Diseases, Eighth Revision [ICD-8] and Tenth Revision [ICD-10] diagnoses) up to age 30 years was examined using stratified Cox proportional hazard regressions that adjusted for 18 covariates, including parental disease history, pregnancy complications, birth weight, Apgar score, sex, socioeconomic markers, and region of Denmark born. Results A total of up to 1 189 061 children were included in this study (48% female); 17 460 underwent adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy; 1 157 684 were in the control group. Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract (relative risk [RR], 1.99; 95% CI, 1.51-2.63 and RR, 2.72; 95% CI, 1.54-4.80; respectively). Smaller increases in risks for infectious and allergic diseases were also found: adenotonsillectomy was associated with a 17% increased risk of infectious diseases (RR, 1.17; 95% CI, 1.10-1.25) corresponding to an absolute risk increase of 2.14% because these diseases are relatively common (12%) in the population. In contrast, the long-term risks for conditions that these surgeries aim to treat often did not differ significantly and were sometimes lower or higher. Conclusions and Relevance In this study of almost 1.2 million children, of whom 17 460 had adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy, surgeries were associated with increased long-term risks of respiratory, infectious, and allergic diseases. Although rigorous controls for confounding were used where such data were available, it is possible these effects could not be fully accounted for. Our results suggest it is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy.
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Affiliation(s)
- Sean G Byars
- Melbourne Integrative Genomics, University of Melbourne, Parkville, Victoria, Australia.,Centre for Social Evolution, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Stephen C Stearns
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut
| | - Jacobus J Boomsma
- Centre for Social Evolution, Department of Biology, University of Copenhagen, Copenhagen, Denmark
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Moirano G, Zugna D, Grasso C, Mirabelli D, Lista P, Ciuffreda L, Segnan N, Merletti F, Richiardi L. Postnatal risk factors for testicular cancer: The EPSAM case-control study. Int J Cancer 2017; 141:1803-1810. [PMID: 28699204 DOI: 10.1002/ijc.30884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 05/23/2017] [Accepted: 06/21/2017] [Indexed: 11/11/2022]
Abstract
Testicular cancer is considered to originate from an impaired differentiation of fetal germ cells, but puberty could represent another time window of susceptibility. Our study aimed at investigating the association between environmental exposures acting during puberty/adolescence (13-19 years of age) and the risk of testicular cancer. We used data of the EPSAM study, a case-control study on germ-cell testicular cancer conducted in the province of Turin, Italy, involving cases diagnosed between 1997 and 2008. Histologically confirmed cases (n = 255) and controls (n = 459) completed a postal questionnaire focusing in particular on the pubertal period (namely age 13 years) with questions on physical activity (competitive sports, gardening), lifestyle (alcohol consumption, smoking), occupational history and medical conditions. All analyses were adjusted for the matching variables, cryptorchidism and educational level. Having done at least one competitive sport during puberty (odds ratio [OR]: 0.72, 95% confidence interval: 0.52-1.00), gardening activities during puberty (OR: 0.62, 0.42-0.94) and having a lower weight than peers during puberty (OR: 0.64, 0.42-0.97) were all inversely associated with the risk of testicular cancer. No evidence of association between smoking or alcohol consumption during puberty and the risk of testicular cancer was observed. Regarding agriculture-related occupations, we found an association with the risk of testicular cancer both for occasional jobs during puberty (OR: 2.40, 95% CI: 1.08-5.29) and ever employment in adolescence (OR: 2.59, 95% CI: 0.83-8.10). Our results suggest that postnatal exposures could play a role in testicular cancer aetiology, at least when acting in puberty or adolescence.
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Affiliation(s)
- Giovenale Moirano
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Daniela Zugna
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Chiara Grasso
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Dario Mirabelli
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Patrizia Lista
- Medical Oncology Division 1, University Hospital "Citta' della Salute e della Scienza", Turin, Italy
| | - Libero Ciuffreda
- Medical Oncology Division 1, University Hospital "Citta' della Salute e della Scienza", Turin, Italy
| | - Nereo Segnan
- Department of Cancer Screening and Unit of Cancer Epidemiology, WHO Collaborative Center for Cancer Early Diagnosis and Screening, CPO Piedmont and University Hospital "Citta' della Salute e della Scienza", Turin, Italy
| | - Franco Merletti
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit-CERMS, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
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Misiukiewicz K, Posner M. Role of Prophylactic Bilateral Tonsillectomy as a Cancer Preventive Strategy. Cancer Prev Res (Phila) 2015; 8:580-2. [PMID: 26100523 DOI: 10.1158/1940-6207.capr-15-0153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/13/2015] [Indexed: 11/16/2022]
Abstract
The rate of vaccination against human papillomavirus (HPV) among adolescent girls and boys over the past few years has been stagnant in spite of the increase in incidence of HPV-positive oropharyngeal (OPX) squamous cell carcinoma (SCC). The indirect relationship between HPV cancer incidence and preventive vaccination poses a public health concern and has caused clinicians to search for other methods toward eradicating the ongoing oropharyngeal carcinoma epidemic. This alarming increase in OPX is motivating a search for therapeutic prevention strategies, including biomarker discovery, risk assessment, therapeutic vaccines, immunotherapy, and surgery. The current Danish Cancer Registry study by Fakhry and colleagues (in this issue) is the first to investigate the impact of prior tonsillectomy on the development of HPV OPX. They report that remote tonsillectomy resulted in a decreased incidence of tonsillar SCC. While thought-provoking, this study has a small sample size. Also, tonsillectomy does not address all anatomic sites at risk; there is lack of well-defined precancerous lesions or biomarkers to identify high-risk patients, and cost and morbidity make it impractical to justify prophylactic tonsillectomy as a cancer preventive strategy at present. The provocative clinical signal reported in this study supports further research and strategies that employ surgery when the technology and epidemiology can reliably be used to identify high-risk subjects.
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Affiliation(s)
| | - Marshall Posner
- Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai, New York, New York
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Wang YP, Wang MC, Lin HC, Lee KS, Chou P. Tonsillectomy and the risk for deep neck infection-a nationwide cohort study. PLoS One 2015; 10:e0117535. [PMID: 25849535 PMCID: PMC4388732 DOI: 10.1371/journal.pone.0117535] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/26/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although the tonsils contribute to first line immunity against foreign pathogens in the upper aero-digestive tract, the association of tonsillectomy with the risk of deep neck infection remains unclear. The aim of this study was to assess the incidence rate and risk of deep neck infection among patients who had undergone a tonsillectomy. METHODS This retrospective cohort study evaluated all patients who had undergone tonsillectomy between 2001 and 2009 as identified from the Taiwan National Health Insurance Research Database. For each post-tonsillectomy patient, 10 age-, sex-, and index date-matched controls without a history of tonsillectomy were randomly selected. Cox Proportional hazard model and propensity score model were performed to evaluate the association between tonsillectomy and deep neck infection after adjusting for demographic and clinical data. RESULTS There were 34 (71.6 cases per 100,000 person-years) and 174 (36.6 cases per 100,000 person-years) patients that developed deep neck infection in the tonsillectomized and comparison cohorts, respectively. After adjusting for covariates, patients who had undergone a tonsillectomy had a 1.71-fold greater risk of deep neck infection by both Cox proportional hazard model (95% confidence interval, 1.13-2.59) and propensity score model (95% confidence interval, 1.10-2.66). This association was not altered regardless of the indication for tonsillectomy (i.e. chronic/recurrent tonsillitis or sleep apnea/hypertrophy of tonsil) (p = 0.9797). CONCLUSIONS Based on our review of a nationwide cohort study we identified that the risk of deep neck infection is significantly increased among patients who have undergone a tonsillectomy. Additional research is needed to explore the possible mechanisms behind these findings.
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Affiliation(s)
- Ying-Piao Wang
- Department of Otolaryngology—Head and Neck Surgery, Mackay Memorial Hospital, #92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei 104, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, #155, Sec. 2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, #46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Mao-Che Wang
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, #155, Sec. 2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan
- Department of Otolaryngology—Head and Neck Surgery, Taipei Veterans General Hospital, #201, Sec. 2 and School of Medicine, National Yang-Ming University, #155, Sec.2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan
| | - Hung-Ching Lin
- Department of Otolaryngology—Head and Neck Surgery, Mackay Memorial Hospital, #92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei 104, Taiwan
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, #46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Kuo-Sheng Lee
- Department of Otolaryngology—Head and Neck Surgery, Mackay Memorial Hospital, #92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei 104, Taiwan
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, #46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, #155, Sec. 2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan
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Sun LM, Chen HJ, Li TC, Sung FC, Kao CH. A nationwide population-based cohort study on tonsillectomy and subsequent cancer incidence. Laryngoscope 2014; 125:134-9. [PMID: 25130597 DOI: 10.1002/lary.24864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/19/2014] [Accepted: 07/11/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS Tonsillectomy is related to increased risk of certain types of cancer. This study evaluates the possible association between tonsillectomy and cancer in Taiwan. METHODS Data from the National Health Insurance system of Taiwan was used. A cohort study consisting of 997 patients with a new diagnosis of tonsillectomy from 2000 to 2005 and a comparison cohort of 3,988 subjects without tonsillectomy were used in the Poisson regression analysis to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of cancers. RESULTS The incidence rate of all cancer types was higher in the tonsillectomy group than in the control group (4.28 vs. 2.97 per 1,000 person-years, respectively), with an IRR = 1.54 and 95% CI of 1.05 to 2.25, but the significant difference was limited to patients with more than 3 years follow-up. Site-specific analysis found no significant association between tonsillectomy and any individual cancer after adjusting for age, sex, hyperlipidemia, hypertension, and diabetes; however, tonsillectomy patients with more than 3 years follow-up had a marginally significantly higher risk for breast cancer development (adjusted IRR = 2.62; CI = 0.97-7.03). CONCLUSION Our study found that Taiwanese people with tonsillectomy have a significantly higher overall risk of developing cancer and a marginally higher risk of developing breast cancer when follow-up is longer than 3 years.
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Affiliation(s)
- Li-Min Sun
- Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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Abstract
It is well-known that cancer surgery can actually promote the growth of some tumors by a variety of mechanisms. There are observational data suggesting that surgery per se can increase the risk of cancer among individuals without a history of clinical cancer. Occult microscopic cancers are exceedingly common in the general population and are held in a dormant state by a balance between cell proliferation and cell death and also an intact host immune surveillance. The catecholamine surge from the stress of surgery and resulting β(2)-adrenergic signaling culminates in a transient and robust increased vascular endothelial growth factor expression locally and systemically that is enough to start tumor angiogenesis and end dormancy. The same catecholamine surge and β(2)-adrenergic signaling impairs cell-mediated immunity at a crucial time. Elegant animal studies have demonstrated that perioperative nonselective β-blockade abrogates surgical stress-induced angiogenesis and tumor growth. Prospective human trials are desperately needed and clinical implications are discussed.
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McCann SE, Thompson LU, Nie J, Dorn J, Trevisan M, Shields PG, Ambrosone CB, Edge SB, Li HF, Kasprzak C, Freudenheim JL. Dietary lignan intakes in relation to survival among women with breast cancer: the Western New York Exposures and Breast Cancer (WEB) Study. Breast Cancer Res Treat 2009; 122:229-35. [PMID: 20033482 DOI: 10.1007/s10549-009-0681-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 12/05/2009] [Indexed: 11/26/2022]
Abstract
Dietary lignan intakes have been associated with reduced breast cancer risks; however, no previous studies have investigated whether lignan intake might be associated with breast cancer survival. We examined the association of dietary lignan intakes with survival in 1122 women with primary, incident, histologically confirmed breast cancer identified between 1996 and 2001, and with vital status determined through December 31, 2006. Diet in the 12-24 months before diagnosis was assessed with an extensive food frequency questionnaire, and potential confounders assessed from an extensive epidemiologic interview and abstracted clinical data. Lignan intake was calculated using published food composition data. Hazard ratios (HR), and 95% confidence intervals (CIs) for dietary lignan intakes with all cause, and breast cancer mortality were estimated using Cox proportional hazards adjusting for age, education, race, total energy intake, tumor stage, and body mass index. Of the 1122 women with complete dietary data, 160 had died by the end of follow-up. Among postmenopausal women only, those in the highest versus lowest quartile of lignan intakes had a statistically significant reduction in the risk of all cause mortality (HR 0.49, 95% CI 0.26-0.91) and a significantly reduced risk of breast cancer mortality (HR 0.29, 95% CI 0.11-0.76). Higher intakes of dried beans (HR 0.61, 95% CI 0.36-1.03), but not fruits, vegetables, or grains, were also weakly associated with overall mortality. In summary, our results suggest that higher lignan intakes may be associated with improved survival among postmenopausal women with breast cancer.
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Affiliation(s)
- Susan E McCann
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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Tonsillectomy may be an indicator of low vitamin D status, a risk factor for cancer later in life. Cancer Causes Control 2009; 20:1235-6. [PMID: 19340596 DOI: 10.1007/s10552-009-9333-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 03/10/2009] [Indexed: 10/20/2022]
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