Cigarette smoking and risk of second primary cancer: a systematic review and meta-analysis

Cigarette smoke modulates methylation levels of LEF1-AS1 and impedes its expression: An experimental study

INTRODUCTION

Cigarette smoke (CS) contains carcinogenic substances and influences genetic regulation and epigenetic modifications, such as DNA methylation. It plays a role in the development of various cancers, including colon, bladder, lung cancer, and leukemia. Long non-coding RNAs play a significant role in controlling several pathways in the cell, including lymphoid enhancer-binding factor 1 antisense RNA 1 (LEF1-AS1), which is found overexpressed in lung, oral, glioblastoma, and colon cancers and downregulated in leukemias. We investigated the impact of CS on DNA methylation of the promoter region of LEF1-AS1 as well as its expression in endothelial cells.

METHODS

This experimental study was designed to investigate the effects of cigarette smoke on the methylation status of the promoter region of LEF1-AS1 in smoker and non-smoker samples and its expression in relevant cell models. To measure the alternations of DNA methylation, extracted DNA samples from 64 male subjects (32 smokers and 32 non-smokers) were bisulfite-treated and amplified using polymerase chain reaction (PCR) with methylation-specific PCR primers. Furthermore, to define the impact of CS on LEF1-AS1 expression, human umbilical vein endothelial cells (HUVECs) were fed with media containing CS for 3 and 6 hours. The expression analysis of LEF1-AS1 was performed using the GTEx (Genotype-Tissue Expression) database, including an assessment of its expression in various cancers such as lung and brain cancers. The functional analysis of the LEF1-AS1 gene was conducted across multiple tissues using data from the GENT2 databases, along with meta-survival and functional enrichment analysis.

RESULTS

The results indicated an average increase of 19.8% in DNA methylation of the promoter region of LEF1-AS1 in the samples from the smokers compared with those from the non-smokers, as well as a significant reduction of LEF1-AS1 expression level in the HUVECs (45% and 83%) after treatment with CS (3 and 6 Hours), respectively. LEF1-AS1 expression varied significantly across tumor types when compared to their normal counterparts. Some cancers, such as lung and brain, showed increased expression, suggesting cancer-specific overexpression of LEF1-AS1. Variability in expression across cancers and normal tissues implies potential heterogeneity in gene regulation. A meta-survival analysis of the LEF1-AS1 gene (e.g. GSE31546, GSE31548, GSE19188), revealed hazard ratios (HR) ranging widely, with some studies (e.g. GSE31546, HR=12.02) suggesting increased risk, though confidence intervals often included 1, indicating uncertainty. Low heterogeneity (I2=16%, p=0.26) suggests consistency among studies, but the overall findings lack strong statistical significance.

CONCLUSIONS

Our findings indicate that CS alters LEF1-AS1 DNA methylation and causes an inhibition of LEF1-AS1 expression.

Practice patterns, experiences, and challenges of German oncology health care staff with smoking cessation in patients with cancer: a cross-sectional survey study

PURPOSE

Often, cancer patients do not receive education about the negative consequences of smoking on the treatment outcome. To support cancer patients in the process of smoking cessation, it is essential to involve oncology staff. This study aims to learn about the experiences and attitudes from the point of view of oncology staff and, thus, how a smoking intervention should be designed. The study aims to engage all oncology staff due to the unclear responsibility for providing smoking cessation education, support, and motivating cancer patients to quit smoking.

METHODS

N = 354 German oncology staff (oncologists, nurses, psycho-oncologists, others) filled out a 5-point Likert scale-based questionnaire regarding practices, potential barriers, and attitudes towards smoking cessation between October 2021 and June 2022. The questionnaire was developed by Derksen et al. (2020), translated and slightly modified for the use of this study. It was distributed to all leading oncology staff in our Cancer Center Network with a request to share with all oncology staff. Flyers were also handed out in all oncology wards and outpatient clinics in the same Cancer Center Network.

RESULTS

Most oncology staff ask cancer patients about their current smoking status (curative, M = 2.27; SD = 1.59; palliative, M = 2.90; SD = 1.83), but they rarely treat or refer patients for a smoking cessation intervention (curative, M = 4.78; SD = 1.20; palliative, M = 4.99; SD = 1.06). Smoking behavior of curative cancer patients is addressed more than that of palliative cancer patients (d =  - 37). Regression analyses of key dependent variables showed that profession, setting, and the belief that continued smoking affects treatment outcome explained the variance of asking patients if they smoke, advising to stop smoking and lack of time (without profession).

CONCLUSION

Involving oncology staff in motivating cancer patients who smoke to quit and referring them to smoking cessation services should take the different attitudes and knowledge of the staff into account to improve treatment that supports tobacco cessation.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer patients have special needs when it comes to a cessation program. In the long term, survivors will benefit from tailored smoking cessation education and services provided by oncology staff to help them quit smoking after a cancer diagnosis.

Therapeutic Approaches with Iron Oxide Nanoparticles to Induce Ferroptosis and Overcome Radioresistance in Cancers

The emergence of nanotechnology in medicine, particularly using iron oxide nanoparticles (IONPs), may impact cancer treatment strategies. IONPs exhibit unique properties, such as superparamagnetism, biocompatibility, and ease of surface modification, making them ideal candidates for imaging, and therapeutic interventions. Their application in targeted drug delivery, especially with traditional chemotherapeutic agents like cisplatin, has shown potential in overcoming limitations such as low bioavailability and systemic toxicity of chemotherapies. Moreover, IONPs, by releasing iron ions, can induce ferroptosis, a form of iron-dependent cell death, which offers a promising pathway to reverse radio- and chemoresistance in cancer therapy. In particular, IONPs demonstrate significant potential as radiosensitisers, enhancing the effects of radiotherapy by promoting reactive oxygen species (ROS) generation, lipid peroxidation, and modulating the tumour microenvironment to stimulate antitumour immune responses. This review explores the multifunctional roles of IONPs in radiosensitisation through ferroptosis induction, highlighting their promise in advancing treatment for head and neck cancers. Additional research is crucial to fully addressing their potential in clinical settings, offering a novel approach to personalised cancer treatment.

A comparative study of health behaviors in adult male cancer survivors and the general male population in Korea: from the Korea national health and nutrition examination survey VII-VIII (2016-2021)

BACKGROUND

As healthy living becomes crucial for cancer survivors, discussing the health risk behaviors of male cancer survivors, who are more prone to such behaviors, is essential. This study compared health-related behaviors and obesity among male cancer survivors and the general male population in Korea.

METHODS

This cross-sectional, matched case-control study used data from the Korea National Health and Nutrition Examination Survey (KNHANES). Of 11,760 participants, 349 cancer survivors and 1,047 controls were matched by propensity scores. Logistic regression evaluated differences in BMI, smoking, alcohol consumption, physical activity, and diet.

RESULTS

Cancer survivors had lower odds of being overweight and higher odds of being former smokers and drinkers than controls. No significant differences were found in physical activity or diet. However, the middle-aged and older cancer survivors were more likely to be overweight and obese, respectively. The middle-aged survivors were also more likely to be former smokers, while the older survivors were more likely to be former drinkers.

CONCLUSION

Cancer survivors were more likely to have a normal weight, be past smokers, or be former drinkers compared with controls. Education on cancer prevention is required to improve health-related behaviors and prevent secondary cancer.

Survival and risk factors for metastatic colorectal cancer patients with a history of prior malignancy

Given concerns about treatment, there is uncertainty surrounding the effect of prior malignancy on the survival of individuals with metastatic colorectal cancer. This study sought to evaluate how prior malignancy impacts the survival of patients with metastatic colorectal cancer (mCRC). Patients diagnosed with stage IV mCRC (per the American Joint Committee on Cancer [AJCC] 6th edition) between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Those without a prior history of malignancy were assigned to the control group, whereas those with a prior history of malignancy were assigned to the research group. Propensity score matching (PSM) was utilized to ensure that the baseline characteristics were balanced. The Kaplan‒Meier method was used for survival analysis, as were the multivariate Cox proportional hazard model and multivariate competing risk model. The PSM analysis included 54365 eligible patients with mCRC. Among them, 4,845 (8.9%) had a history of prior malignancy. A history of prior malignancy was associated with a greater cancer-specific survival rate (adjusted hazard ratio (AHR) ) = 0.49; 95% CI [0.47-0.51]). Subgroup analyses revealed that a prior diagnosis of a skin tumour (AHR = 1.37; 95% CI [1.11-1.69]) and a history of prior malignancy of more than five years (AHR = 1.39; 95% CI [1.23-1.57]) had adverse effects on the clinical outcomes of patients with mCRC. Our findings suggest that patients with a prior malignancy diagnosis may experience prolonged survival. Subgroup analysis indicated that a malignancy diagnosed more than 5 years ago may adversely impact the clinical outcomes of patients with mCRC. Therefore, we advocate for active standardized treatment for these patients and propose expanding the range of prior malignancies included in clinical trials based on publication timelines, primary tumour locations, and genetic testing results. The objective is to facilitate timely and proactive treatment for patients following the disclosure of results, thereby instilling confidence in the management of mCRC.

Squamous Cell Carcinoma of the Conjunctiva: A Population-Based Study on Epidemiologic Trends, Cancer-Specific Survival Patterns, and the Risk of Second Malignant Neoplasms, 1975 to 2016

PURPOSE

To analyze the national epidemiologic trends of squamous cell carcinoma of the conjunctiva (SCCC) over 4 decades, providing the largest report on disease-specific survival (DSS) outcomes and investigating the risk of developing second primary neoplasms in these patients.

METHODS

This retrospective, population-based cohort study analyzed 1,172 patients diagnosed with SCCC from January 1, 1975, through December 31, 2016. Data were extracted from the US Surveillance, Epidemiology, and End Results database. Incidence, DSS, and the relative risk (95% confidence interval) of developing second primary neoplasms were studied.

RESULTS

SCCC incidence (0.45/million/year) increased during the study's time period (regression coefficient = 0.004, p = 0.002), primarily due to an increasing incidence in women (regression coefficient = 0.004, p = 0.003) and in White (regression coefficient = 0.006, p = 0.007) patients. The 5-year DSS was 95.4%. Sex and race did not impact survival. Patients residing in the Midwestern United States exhibited the lowest survival compared with other regions with a 5-year DSS of 85.2% (p = 0.008). White male SCCC patients are at an increased risk, compared with the general population, of developing second primary neoplasms of the liver (relative risk = 4.8 [1.3-12.4]; p < 0.05), respiratory tract (relative risk = 2.3 [1.4-3.6]; p < 0.05), and skin (relative risk = 3.7 [1.8-6.9]; p < 0.05).

CONCLUSIONS

SCCC incidence has been increasing in the United States. DSS is substantially higher than the overall survival previously reported in the literature. The area of residence significantly impacts survival. White men with SCCC are at an increased risk of developing second primary neoplasms of different organ systems.

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

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

Risk factors for second primary cancer in a prospective cohort of endometrial cancer survivors: an Alberta Endometrial Cancer Cohort Study

We examined associations between modifiable and nonmodifiable cancer-related risk factors measured at endometrial cancer diagnosis and during early survivorship (~3 years postdiagnosis) with second primary cancer (SPC) risk among 533 endometrial cancer survivors in the Alberta Endometrial Cancer Cohort using Fine and Gray subdistribution hazard models. During a median follow-up of 16.7 years (IQR, 12.2-17.9), 89 (17%) participants developed an SPC; breast (29%), colorectal (13%), and lung (12%) cancers were the most common. Dietary glycemic load before endometrial cancer diagnosis (≥90.4 vs < 90.4 g/day: subhazard ratio [sHR] = 1.71; 95% CI, 1.09-2.69), as well as older age (≥60 vs < 60 years: sHR = 2.48; 95% CI, 1.34-4.62) and alcohol intake (≥2 drinks/week vs none: sHR = 3.81; 95% CI, 1.55-9.31) during early survivorship, were associated with increased SPC risk. Additionally, reductions in alcohol consumption from prediagnosis to early survivorship significantly reduced SPC risk (sHR = 0.34; 95% CI, 0.14-0.82). With 1 in 6 survivors developing an SPC, further investigation of SPC risk factors and targeted surveillance options for high-risk survivors could improve long-term health outcomes in this population. Reductions in dietary glycemic load and alcohol intake from prediagnosis to early survivorship showed promising risk reductions for SPCs and could be important modifiable risk factors to target among endometrial cancer survivors. This article is part of a Special Collection on Gynecological Cancer.

Incident Myocardial Infarction, Heart Failure, and Oncologic Outcomes in Breast Cancer Survivors

Background

Cardiovascular disease (CVD) is associated with higher rates of incident cancer. Data are scarce regarding the association of incident CVD with oncologic outcomes after a cancer diagnosis.

Objectives

This study sought to determine whether incident myocardial infarction (MI) or heart failure (HF) in breast cancer survivors is associated with oncologic outcomes.

Methods

This was a population-based cohort study in Ontario, Canada, using linked administrative data sets of women diagnosed with first breast cancer between April 1, 2007, and March 31, 2015. A landmark analysis was conducted of women alive 2 years after breast cancer diagnosis, aged ≥40 years, and with available staging data and without recurrent/distant disease or preceding CVD. The exposure was a composite of MI and/or HF after the landmark date. The outcomes were cancer mortality, new non-breast malignancy diagnosis, and new chemotherapy initiation. Multivariable cause-specific hazards regression was used to determine the association of incident MI/HF (time-varying exposure) with outcomes.

Results

A total of 30,694 women (median age of 60 years) were included, of whom 1,346 developed incident MI/HF at a median of 3.9 years after the landmark date. At 5 years, the cumulative incidence was 5.9% (95% CI: 5.6%-6.1%) for cancer death, 4.3% (95% CI: 4.1%-4.6%) for non-breast malignancy, and 25.7% (95% CI: 25.2%-26.2%) for new chemotherapy. Incident MI/HF was associated with a higher hazard of cancer death (HR: 3.94; 95% CI: 3.38-4.59), non-breast malignancy (HR: 1.39; 95% CI: 1.06-1.82), and new chemotherapy (HR: 1.25; 95% CI: 1.02-1.53).

Conclusions

Incident MI and/or HF after breast cancer treatment are associated with higher hazards of adverse oncologic outcomes, highlighting the need to prioritize care for these patients.

Oncologists' communication about tobacco and alcohol use during treatment for esophagogastric cancer: a qualitative observational study of simulated consultations

PURPOSE

Tobacco and alcohol use influence cancer risk as well as treatment outcomes, specifically for esophageal and gastric cancer patients. Therefore, it is an important topic to discuss during consultations. This study aims to uncover medical, radiation, and surgical oncologists' communication about substance use, i.e., tobacco and alcohol use, in simulated consultations about curative and palliative esophagogastric cancer treatment.

METHODS

Secondary analyses were performed on n = 40 standardized patient assessments (SPAs) collected in three Dutch clinical studies. Simulated patients with esophagogastric cancer were instructed to ask about smoking or alcohol use during treatment. The responses of the 40 medical, radiation, and surgical oncologists were transcribed verbatim, and thematic analysis was performed in MAXQDA.

RESULTS

Oncologists consistently advocated smoking cessation during curative treatment. There was more variation in their recommendations and arguments in the palliative compared to the curative setting and when addressing alcohol use instead of smoking. Overall, oncologists were less stringent regarding behavior change in the palliative than in the curative setting. Few oncologists actively inquired about the patient's perspective on the substance use behavior, the recommended substance use change, or the support offered.

CONCLUSION

Clear guidelines for oncologists on when and how to provide unequivocal recommendations about substance use behavior change and support to patients are needed. Oncologists might benefit from education on how to engage in a conversation about smoking or alcohol.

Cigarette Smoke-Induced Epithelial-to-Mesenchymal Transition: Insights into Cellular Mechanisms and Signaling Pathways

This review delves into the molecular complexities underpinning the epithelial-to-mesenchymal transition (EMT) induced by cigarette smoke (CS) in human bronchial epithelial cells (HBECs). The complex interplay of pathways, including those related to WNT//β-catenin, TGF-β/SMAD, hypoxia, oxidative stress, PI3K/Akt, and NF-κB, plays a central role in mediating this transition. While these findings significantly broaden our understanding of CS-induced EMT, the research reviewed herein leans heavily on 2D cell cultures, highlighting a research gap. Furthermore, the review identifies a stark omission of genetic and epigenetic factors in recent studies. Despite these shortcomings, the findings furnish a consolidated foundation not only for the academic community but also for the broader scientific and industrial sectors, including large tobacco companies and manufacturers of related products, both highlighting areas of current understanding and identifying areas for deeper exploration. The synthesis herein aims to propel further research, hoping to unravel the complexities of the EMT in the context of CS exposure. This review not only expands our understanding of CS-induced EMT but also reveals critical limitations in current methodologies, primarily the reliance on 2D cell cultures, which may not adequately simulate more complex biological interactions. Additionally, it highlights a significant gap in the literature concerning the genetic and epigenetic factors involved in CS-induced EMT, suggesting an urgent need for comprehensive studies that incorporate these types of experiments.

Second primary non-breast cancers in young breast cancer survivors

PURPOSE

We evaluated the incidence, timing, and risk factors for second primary non-breast cancers (SPNBC) among young breast cancer (BC) survivors.

METHODS

This study included participants of the Young Women's BC Study (YWS) who were diagnosed with stage 0-III BC between 2006 and 2016 and age 40 or younger at diagnosis (N = 1,230). Patient characteristics, treatment information, and clinical events were collected via serial surveys. Tumor and treatment data were obtained from medical record review. Five- and 10-year risks of SPNBCs were estimated via the cumulative incidence function, considering death, metastasis, or second primary BC as competing events. Fine and Gray subdistribution hazard models estimated subdistribution hazard ratios (sHRs) and 95% confidence intervals (CI) for SPNBC risk based on risk factors including demographics, germline genetics, primary BC characteristics, and treatments.

RESULTS

Among 1,230 women, over a median follow-up of 10.1 years, 47 patients (4%) developed an SPNBC. Types of malignancy included melanoma (n = 10), thyroid (n = 10), ovarian (n = 4), sarcoma (n = 4), uterine (n = 3), rectal (n = 3), bladder (n = 2), cervical (n = 2), head/neck (n = 2), lung (n = 2), lymphoma (n = 2), pancreatic (n = 2), and renal (n = 1). Five and 10-year cumulative incidence were 1.4% and 3.2%, respectively. Median time between primary BC and SPNBC was 7.3 years. No patient factors, primary tumor characteristics, or treatments were statistically significantly associated with SPNBC in univariable or multivariable models.

CONCLUSION

In this population, five-year cumulative incidence was higher than that reported among healthy women under 50 years of age, highlighting the importance of long-term surveillance for new non-breast cancers in young adult BC survivors.

Association of Domestic Water Hardness with All-Cause and Cause-Specific Cancers: Evidence from 447,996 UK Biobank Participants

BACKGROUND

Accumulating evidence suggests that domestic water hardness is linked to health outcomes, but its association to all-cause and cause-specific cancers warrants investigation.

OBJECTIVE

The aim of this study was to investigate the association of domestic hard water with all-cause and cause-specific cancers.

METHODS

In the prospective cohort study, a total of 447,996 participants from UK Biobank who were free of cancer at baseline were included and followed up for 16 y. All-cause and 22 common cause-specific cancer diagnoses were ascertained using hospital inpatient records and self-reported data until 30 November 2022. Domestic water hardness, measured by CaCO 3 concentrations, was obtained from the local water supply companies across England, Scotland, and Wales in 2005. Data were analyzed using Cox proportional hazard models, with adjustments for known measured confounders, including demographic, socioeconomic, clinical, biochemical, lifestyle, and environmental factors.

RESULTS

Over a median follow-up of 13.6 y (range: 12.7-14.4 y), 58,028 all-cause cancer events were documented. A U-shaped relationship between domestic water hardness and all-cause cancers was observed (p for nonlinearity < 0.001 ). In comparison with individuals exposed to soft water (0 - 60 mg / L ), the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause cancer were 1.00 (95% CI: 0.98, 1.02) for those exposed to moderate hard water (> 60 - 120 mg / L ), 0.88 (95% CI: 0.84, 0.91) for those exposed to hard water (> 120 - 180 mg / L ) and 1.06 (95% CI: 1.04, 1.08) for those exposed to very hard water (> 180 mg / L ). Additionally, domestic water hardness was associated with 11 of 22 cause-specific cancers, including cancers of the esophagus, stomach, colorectal tract, lung, breast, prostate, and bladder, as well as non-Hodgkin lymphoma, multiple myeloma, malignant melanoma, and hematological malignancies. Moreover, we observed a positive linear relationship between water hardness and bladder cancer.

DISCUSSION

Our findings suggest that domestic water hardness was associated with all-cause and multiple cause-specific cancers. Findings from the UK Biobank support a potentially beneficial association between hard water and the incidence of all-cause cancer. However, very hard water may increase the risk of all-cause cancer. https://doi.org/10.1289/EHP13606.

Examining the Association between Abstinence from Smoking and Healthcare Costs among Patients with Cancer

Continuous tobacco use in patients with cancer is linked to substantial healthcare costs due to increased risks and complications, whereas quitting smoking leads to improved treatment outcomes and cost reductions. Addressing the need for empirical evidence on the economic impact of smoking cessation, this study examined the association between smoking cessation and healthcare cost utilization among a sample of 930 patients with cancer treated at The University of Texas MD Anderson Cancer Center's Tobacco Research and Treatment Program (TRTP). Applying conditional quantile regression and propensity scores to address confounding, our findings revealed that abstinence achieved through the TRTP significantly reduced the median cost during a 3-month period post-quitting by $1,095 [β = -$1,095, P = 0.007, 95% confidence interval (CI), = (-$1,886 to -$304)]. Sensitivity analysis corroborated these conclusions, showing a pronounced cost reduction when outlier data were excluded. The long-term accrued cost savings from smoking cessation could potentially offset the cost of participation in the TRTP program, underscoring its cost effectiveness. An important implication of this study is that by reducing smoking rates, healthcare systems can more efficiently allocate resources, enhance patient health outcomes, and lessen the overall cancer burden.

PREVENTION RELEVANCE

This study emphasizes the dual impact of smoking cessation programs in patients with cancer: quitting smoking and reducing healthcare costs. It highlights the importance of integrating cessation programs into cancer prevention strategies, ensuring both individual health benefits and broader, system-wide economic efficiencies. See related Spotlight, p. 197.

Greater physical activity levels are associated with lower prevalence of tumors and risk of cancer in Spanish population: A cross-sectional study

Cancer is a leading cause of death worldwide and insufficient physical activity is a significant risk factor. This study analyzed the tumor prevalence based on sex, age, smoking, BMI, and physical activity level (PAL) in the Spanish people. Data from the Spanish National Health Survey (ENSE) was used, comprising a sample of 17,704 people diagnosed with malignant tumors. The findings revealed compelling associations (P < 0.001) between all variables examined and the prevalence of malignant tumors. Notably, women exhibited a higher prevalence than men (P < 0.05). Furthermore, individuals classified as obese displayed a greater prevalence of tumors than those within the normal weight range (P < 0.05). The analysis also showed that the inactive group had a higher prevalence of malignant tumors than the active group (P < 0.05). This study identified significant dependency relationships (P < 0.001) between PAL and the various population groups examined. Additionally, the general population analyzed in the ENSE2017 study demonstrated a reduced risk of developing malignant tumors among the active (P < 0.05) and very active groups (P < 0.05) compared to the inactive group. This risk reduction was consistently observed across different subgroups, including men, women, specific age groups, smoking, and BMI categories (P < 0.05). This study highlighted the importance of regular physical activity in reducing the risk and prevalence of malignant tumors in the Spanish population. These findings underscore the critical role of engaging in physical activity as a protective measure against cancer. Encouraging individuals to adopt an active lifestyle could significantly contribute to cancer prevention efforts and promote overall well-being.

Healthcare utilization and cost barriers among U.S. childhood cancer survivors

BACKGROUND

To evaluate healthcare utilization and cost barrier patterns among childhood cancer survivors (CCS) compared with noncancer controls.

PROCEDURE

Using the 2014-2019 Behavioral Risk Factor Surveillance System, we identified CCS < 50 years and matched controls. We used chi-squared tests to compare characteristics between the two groups. Logistic regression analyses were used to assess the likelihood of having a checkup, receiving influenza vaccine, and experiencing healthcare cost barriers (being unable to see the doctor due to cost) during the past 12 months. Conditional models accounted for the matching.

RESULTS

We included 231 CCS and 692 controls. CCS had lower household income (p < 0.001), lower educational attainment (p = 0.021), more chronic health conditions (p < 0.001), and a higher proportion of being current smokers (p = 0.005) than controls. Both groups had similar rates of having a checkup and influenza vaccine; however, a quarter of CCS experienced healthcare cost barriers compared with 13.9% in controls (p = 0.001; regression findings: adjusted odds ratio (aOR) = 1.72, 95% confidence interval (CI): 1.11-2.65). Compared with the youngest CCS group (18-24 years), CCS ages 25-29 years were five times more likely to experience healthcare cost barriers (aOR = 4.79; 95% CI, 1.39-16.54). Among CCS, current smokers were less likely to have a checkup (aOR = 0.46; 95% CI, 0.23-0.94). Uninsured CCS were less likely to have a checkup (aOR = 0.33; 95% CI, 0.14-0.75) and ∼8 times more likely to experience healthcare cost barriers (aOR = 8.28; 95% CI, 3.45-19.88).

CONCLUSION

CCS being 25-29 years, uninsured, or current smokers encounter inferior outcomes in healthcare utilization and cost barriers. We suggest emphasis on programs on care transition and smoking cessation for CCS.

Pre-diagnostic cigarette smoking and risk of second primary cancer: The Melbourne Collaborative Cohort Study

Enhanced survival following a diagnosis of cancer has led to a steep rise in the number of individuals diagnosed with a second primary cancer. We examined the association between pre-cancer cigarette smoking and risk of second cancer in 9785 participants diagnosed with first invasive cancer after enrolment in the Melbourne Collaborative Cohort Study. Follow-up was from date of first invasive cancer until diagnosis of second primary invasive cancer, death, or 31 July 2019, whichever came first. Data on cigarette smoking was collected at enrolment (1990-94) along with information on other lifestyle factors including body size, alcohol intake and diet. We estimated hazard ratios (HR) and 95 % confidence intervals (CI) for incident second cancer with several smoking measures, adjusted for potential confounders. After a mean follow-up of 7.3 years, 1658 second cancers were identified. All measures of smoking were associated with increased risk of second cancer. We observed a 44 % higher risk of second cancer for smokers of ≥ 20 cigarettes/day (HR=1.44, 95 % CI: 1.18-1.76), compared with never smokers. We also observed dose-dependent associations with number of cigarettes smoked (HR=1.05 per 10 cigarettes/day, 95 % CI: 1.01-1.09) and duration of smoking (HR=1.07 per 10 years, 95 % CI: 1.03-1.10). The risk of second cancer increased by 4 % per 10 pack-years of smoking (HR=1.04, 95 % CI: 1.02-1.06; p < 0.001). There was suggestive evidence of stronger associations with number of cigarettes smoked and pack-years of smoking for women (pinteraction<0.05), particularly for the highest risk categories of both variables. These associations with pre-diagnostic smoking were markedly stronger for second cancers known to be smoking-related than for others (phomogeneity<0.001). Our findings for pre-diagnostic cigarette smoking indicated increased risk of second primary cancer for cancer sites considered smoking-related, highlighting the importance of assessing smoking habits in cancer survivors.

The Effect of Smoking Cessation on Acute Pain: A Systematic Review

Smoking is a known risk factor for developing various pain-related disorders. However, acute pain often triggers the craving for cigarette consumption, resulting in a positive feedback mechanism. In addition, there is evidence of decreased pain tolerance during the early stages of abstinence. Therefore, in this study, we aimed to investigate whether a period of decreased pain tolerance and increased pain intensity occurs during smoking cessation. A systematic literature search was conducted through PubMed and Web of Science databases for controlled studies investigating the influence of smoking cessation on acute (defined as pain presentation of < 3 months) and postoperative pain. The outcomes of interest included pain perception threshold, pain tolerance, pain intensity, and postoperative opioid requirements. The search strategy yielded 1478 studies, of which 13 clinical studies met our inclusion criteria. The included studies collectively represented data from 1721 participants from four countries. Of these, 43.3% of the included individuals were females. The mean age of the included subjects was 44.2 ± 8.2 years. The duration of smoking cessation varied considerably. The shortest duration was 2 h; others investigated the effect after more than 1 month of smoking cessation. Smokers had a history of 14.6 ± 9.9 years of nicotine abuse. The mean number of daily smoked cigarettes was 17.5 ± 10.3. Most studies examined in this systematic review show a negative influence of smoking cessation on acute pain. However, the affected pain modalities, the duration of the altered pain perception, and whether male and female smokers are equally affected could not be ascertained due to high heterogeneity and few available studies.

The Prognostic Impact of Quitting Smoking at or around Diagnosis on the Survival of Patients with Gastrointestinal Cancers: A Systematic Literature Review

Simple Summary

Smokers are at high risk of cancer of the gastrointestinal system, and many patients with newly diagnosed cancer of the oesophagus, stomach, colon-rectum, and liver are active smokers at diagnosis. In this review, we focused on whether stopping smoking shortly before diagnosis or afterwards (e.g., during treatment) may improve the chance of survival for these patients. We reviewed the scientific literature up to April 2022 and found only seven articles focusing on this topic. While very limited in number, these studies provided suggestive evidence in favour of a beneficial effect of smoking cessation for these patients. Smokers with newly diagnosed cancer of the gastrointestinal system should be encouraged to stop smoking and provided all the necessary support to achieve this goal.

Abstract

Cigarette smoking is a strong risk factor for the occurrence of gastrointestinal cancers, and a substantial proportion of newly diagnosed patients is made up of active smokers, yet the impact of smoking cessation at or around diagnosis on the clinical course of these cancers (whose prognosis is often unfavourable) has never been summarized to date. We reviewed studies published until 30 April 2022 that investigated whether smoking cessation at or around diagnosis favourably affects the clinical course of gastrointestinal cancers patients. Six studies were included for colorectal cancer patients, which provided limited yet suggestive evidence that quitters may have longer disease-specific survival compared to continued smokers. Only one study each focused on patients with gastric or HBV-positive liver cancer (both reporting a survival advantage for quitters vs. continued smokers), while we found no eligible studies for patients with cancer at other sites within the digestive system. More research is urgently needed to expand the evidence on the topic, given the potentially major clinical implications for these patients. Moreover, health professionals should provide the necessary smoking cessation support to any smoker who is undergoing diagnostic work-up or treatment for gastrointestinal cancer.