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Nyberg T, Brook MN, Ficorella L, Lee A, Dennis J, Yang X, Wilcox N, Dadaev T, Govindasami K, Lush M, Leslie G, Lophatananon A, Muir K, Bancroft E, Easton DF, Tischkowitz M, Kote-Jarai Z, Eeles R, Antoniou AC. CanRisk-Prostate: A Comprehensive, Externally Validated Risk Model for the Prediction of Future Prostate Cancer. J Clin Oncol 2023; 41:1092-1104. [PMID: 36493335 PMCID: PMC9928632 DOI: 10.1200/jco.22.01453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/26/2022] [Accepted: 10/07/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Prostate cancer (PCa) is highly heritable. No validated PCa risk model currently exists. We therefore sought to develop a genetic risk model that can provide personalized predicted PCa risks on the basis of known moderate- to high-risk pathogenic variants, low-risk common genetic variants, and explicit cancer family history, and to externally validate the model in an independent prospective cohort. MATERIALS AND METHODS We developed a risk model using a kin-cohort comprising individuals from 16,633 PCa families ascertained in the United Kingdom from 1993 to 2017 from the UK Genetic Prostate Cancer Study, and complex segregation analysis adjusting for ascertainment. The model was externally validated in 170,850 unaffected men (7,624 incident PCas) recruited from 2006 to 2010 to the independent UK Biobank prospective cohort study. RESULTS The most parsimonious model included the effects of pathogenic variants in BRCA2, HOXB13, and BRCA1, and a polygenic score on the basis of 268 common low-risk variants. Residual familial risk was modeled by a hypothetical recessively inherited variant and a polygenic component whose standard deviation decreased log-linearly with age. The model predicted familial risks that were consistent with those reported in previous observational studies. In the validation cohort, the model discriminated well between unaffected men and men with incident PCas within 5 years (C-index, 0.790; 95% CI, 0.783 to 0.797) and 10 years (C-index, 0.772; 95% CI, 0.768 to 0.777). The 50% of men with highest predicted risks captured 86.3% of PCa cases within 10 years. CONCLUSION To our knowledge, this is the first validated risk model offering personalized PCa risks. The model will assist in counseling men concerned about their risk and can facilitate future risk-stratified population screening approaches.
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Affiliation(s)
- Tommy Nyberg
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mark N. Brook
- Oncogenetics Team, Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Lorenzo Ficorella
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Andrew Lee
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Xin Yang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Naomi Wilcox
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Tokhir Dadaev
- Oncogenetics Team, Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Koveela Govindasami
- Oncogenetics Team, Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Michael Lush
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Goska Leslie
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Kenneth Muir
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Elizabeth Bancroft
- Oncogenetics Team, Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
- Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Zsofia Kote-Jarai
- Oncogenetics Team, Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Rosalind Eeles
- Oncogenetics Team, Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
- Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Antonis C. Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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W AC, GJ N, T M, A A, A T, AL W, A R, S UL, J U, D M, R I, MJA P, K P. The impact of socio-economic deprivation on recovery following robotic assisted radical cystectomy. Urologia 2022; 90:136-140. [PMID: 35673803 DOI: 10.1177/03915603221100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Despite enhanced recovery programmes, length of stay is variable following robotic assisted radical cystectomy (RARC). The aim of this study was to assess the impact socioeconomic deprivation on recovery following RARC. Methods: The prospectively maintained RARC databases at two tertiary referral hospitals were reviewed from 2015 to 2017. Demographic, histological, and outcome data including length of stay (LOS), operation time and blood loss were recorded. The Index of Multiple Deprivation, was chosen as a deprivation index as this is used by the UK government to direct funding and resources to regions, towns and postal codes by assessing a number of indicators. Results: During the study period, 340 consecutive patients underwent RARC. Deprivation deciles were significantly higher in site 1 patients (7.9 in site 1 vs 6.6 in site 2, p < 0.001) implying that these patients are more likely to have higher incomes, levels of education and improved living environments. The mean operating time was longer in the site 1 cohort (397 vs 366 min, p > 0.001) with a reduced mean blood loss volume (252 and 484 mL, p < 0.001). There was a significant difference in mean LOS (6.2 days in site 1 vs 10.6 days in site 2, p < 0.001). On multivariable analysis, a higher deprivation decile did not predict LOS (OR = 1, 95% CI = 0.9–1.1, p = 0.407). Sex and operation site were however significantly associated with LOS (p = 0.006 and <0.001). Conclusion: Recovery following RARC was independent of socioeconomic status when comparing two hospitals with diverse catchment areas in the UK.
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Affiliation(s)
- Abou Chedid W
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Nason GJ
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Mahesan T
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Ashton A
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Tay A
- Department of Urology, St George’s Hospital, London, UK
| | - Walsh AL
- Department of Urology, St George’s Hospital, London, UK
| | - Roodhouse A
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Uribe-Lewis S
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Uribe J
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Moschonas D
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Issa R
- Department of Urology, St George’s Hospital, London, UK
| | - Perry MJA
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Patil K
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
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Socioeconomic inequalities in cancer incidence in Europe: a comprehensive review of population-based epidemiological studies. Radiol Oncol 2020; 54:1-13. [PMID: 32074075 PMCID: PMC7087422 DOI: 10.2478/raon-2020-0008] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Background Since the end of the previous century, there has not been a comprehensive review of European studies on socioeconomic inequality in cancer incidence. In view of recent advances in data source linkage and analytical methods, we aimed to update the knowledge base on associations between location-specific cancer incidence and individual or area-level measures of socio-economic status (SES) among European adults. Materials and methods We systematically searched three databases (PubMed, Scopus and Web of Science) for articles on cancer incidence and SES. Qualitative synthesis was performed on the 91 included English language studies, published between 2000 and 2019 in Europe, which focused on adults, relied on cancer registry data and reported on relative risk (RR) estimates. Results Adults with low SES have increased risk of head and neck, oesophagogastric, liver and gallbladder, pancreatic, lung, kidney, bladder, penile and cervical cancers (highest RRs for lung, head and neck, stomach and cervix). Conversely, high SES is linked with increased risk of thyroid, breast, prostate and skin cancers. Central nervous system and haematological cancers are not associated with SES. The positive gap in testicular cancer has narrowed, while colorectal cancer shows a varying pattern in different countries. Negative associations are generally stronger for men compared to women. Conclusions In Europe, cancers in almost all common locations are associated with SES and the inequalities can be explained to a varying degree by known life-style related factors, most notably smoking. Independent effects of many individual and area SES measures which capture different aspects of SES can also be observed.
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Dasgupta P, Baade PD, Aitken JF, Ralph N, Chambers SK, Dunn J. Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence. Front Oncol 2019; 9:238. [PMID: 31024842 PMCID: PMC6463763 DOI: 10.3389/fonc.2019.00238] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage. Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale. Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease. Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Nicholas Ralph
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,St Vincent's Private Hospital, Toowoomba, QLD, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Suzanne Kathleen Chambers
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, WA, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Jeff Dunn
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
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Socioeconomic status and site-specific cancer incidence, a Bayesian approach in a French Cancer Registries Network study. Eur J Cancer Prev 2018; 27:391-398. [DOI: 10.1097/cej.0000000000000326] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Hugosson J, Godtman RA, Carlsson SV, Aus G, Grenabo Bergdahl A, Lodding P, Pihl CG, Stranne J, Holmberg E, Lilja H. Eighteen-year follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial: effect of sociodemographic variables on participation, prostate cancer incidence and mortality. Scand J Urol 2017; 52:27-37. [PMID: 29254399 DOI: 10.1080/21681805.2017.1411392] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study examined whether previously reported results, indicating that prostate-specific antigen (PSA) screening can reduce prostate cancer (PC) mortality regardless of sociodemographic inequality, could be corroborated in an 18 year follow-up. MATERIALS AND METHODS In 1994, 20,000 men aged 50-64 years were randomized from the Göteborg population register to PSA screening or control (1:1) (study ID: ISRCTN54449243). Men in the screening group (n = 9950) were invited for biennial PSA testing up to the median age of 69 years. Prostate biopsy was recommended for men with PSA ≥2.5 ng/ml. Last follow-up was on 31 December 2012. RESULTS In the screening group, 77% (7647/9950) attended at least once. After 18 years, 1396 men in the screening group and 962 controls had been diagnosed with PC [hazard ratio 1.51, 95% confidence interval (CI) 1.39-1.64]. Cumulative PC mortality was 0.98% (95% CI 0.78-1.22%) in the screening group versus 1.50% (95% CI 1.26-1.79%) in controls, an absolute reduction of 0.52% (95% CI 0.17-0.87%). The rate ratio (RR) for PC death was 0.65 (95% CI 0.49-0.87). To prevent one death from PC, the number needed to invite was 231 and the number needed to diagnose was 10. Systematic PSA screening demonstrated greater benefit in PC mortality for men who started screening at age 55-59 years (RR 0.47, 95% CI 0.29-0.78) and men with low education (RR 0.49, 95% CI 0.31-0.78). CONCLUSIONS These data corroborate previous findings that systematic PSA screening reduces PC mortality and suggest that systematic screening may reduce sociodemographic inequality in PC mortality.
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Affiliation(s)
- Jonas Hugosson
- a Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Rebecka Arnsrud Godtman
- a Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Sigrid V Carlsson
- a Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden.,b Department of Surgery (Urology Service) , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,c Department of Epidemiology and Biostatistics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Gunnar Aus
- d Department of Urology , Carlanderska Hospital , Gothenburg , Sweden
| | - Anna Grenabo Bergdahl
- a Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Pär Lodding
- a Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Carl-Gustaf Pihl
- e Department of Pathology, Institute of Biomedicine , Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden
| | - Johan Stranne
- a Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Erik Holmberg
- f Department of Oncology, Institute of Clinical Sciences , Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden
| | - Hans Lilja
- b Department of Surgery (Urology Service) , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,g Department of Laboratory Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,h Department of Medicine (Genitourinary Oncology Service) , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,i Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK.,j Department of Translational Medicine , Lund University, Skåne University Hospital , Malmö , Sweden
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Tweed EJ, Allardice GM, McLoone P, Morrison DS. Socio-economic inequalities in the incidence of four common cancers: a population-based registry study. Public Health 2017; 154:1-10. [PMID: 29128730 PMCID: PMC5764071 DOI: 10.1016/j.puhe.2017.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/20/2017] [Accepted: 10/05/2017] [Indexed: 12/20/2022]
Abstract
Objectives To investigate the relationship between socio-economic circumstances and cancer incidence in Scotland in recent years. Study design Population-based study using cancer registry data. Methods Data on incident cases of colorectal, lung, female breast, and prostate cancer diagnosed between 2001 and 2012 were obtained from a population-based cancer registry covering a population of approximately 2.5 million people in the West of Scotland. Socio-economic circumstances were assessed based on postcode of residence at diagnosis, using the Scottish Index of Multiple Deprivation (SIMD). For each cancer, crude and age-standardised incidence rates were calculated by quintile of SIMD score, and the number of excess cases associated with socio-economic deprivation was estimated. Results 93,866 cases met inclusion criteria, comprising 21,114 colorectal, 31,761 lung, 23,757 female breast, and 15,314 prostate cancers. Between 2001 and 2006, there was no consistent association between socio-economic circumstances and colorectal cancer incidence, but 2006–2012 saw an emerging deprivation gradient in both sexes. The incidence rate ratio (IRR) for colorectal cancer between most deprived and least deprived increased from 1.03 (95% confidence interval [CI] 0.91–1.16) to 1.24 (95% CI 1.11–1.39) during the study period. The incidence of lung cancer showed the strongest relationship with socio-economic circumstances, with inequalities widening across the study period among women from IRR 2.66 (95% CI 2.33–3.05) to 2.91 (95% CI 2.54–3.33) in 2001–03 and 2010–12, respectively. Breast and prostate cancer showed an inverse relationship with socio-economic circumstances, with lower incidence among people living in more deprived areas. Conclusion Significant socio-economic inequalities remain in cancer incidence in the West of Scotland, and in some cases are increasing. In particular, this study has identified an emerging, previously unreported, socio-economic gradient in colorectal cancer incidence among women as well as men. Actions to prevent, mitigate, and undo health inequalities should be a public health priority. There is an emerging social gradient in colorectal cancer incidence in both sexes. Profound socio-economic inequalities in lung cancer persist. Breast and prostate cancer remain more common among less deprived populations.
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Affiliation(s)
- E J Tweed
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK; Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK.
| | - G M Allardice
- Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK
| | - P McLoone
- Department of Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - D S Morrison
- Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK; Department of Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
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Lane JA, Oliver SE, Appleby PN, Lentjes MAH, Emmett P, Kuh D, Stephen A, Brunner EJ, Shipley MJ, Hamdy FC, Neal DE, Donovan JL, Khaw KT, Key TJ. Prostate cancer risk related to foods, food groups, macronutrients and micronutrients derived from the UK Dietary Cohort Consortium food diaries. Eur J Clin Nutr 2017; 71:274-283. [PMID: 27677361 PMCID: PMC5215092 DOI: 10.1038/ejcn.2016.162] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 04/29/2016] [Accepted: 07/14/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVES The influence of dietary factors remains controversial for screen-detected prostate cancer and inconclusive for clinically detected disease. We aimed to examine these associations using prospectively collected food diaries. SUBJECTS/METHODS A total of 1,717 prostate cancer cases in middle-aged and older UK men were pooled from four prospective cohorts with clinically detected disease (n=663), with routine data follow-up (means 6.6-13.3 years) and a case-control study with screen-detected disease (n=1054), nested in a randomised trial of prostate cancer treatments (ISCTRN 20141297). Multiple-day food diaries (records) completed by men prior to diagnosis were used to estimate intakes of 37 selected nutrients, food groups and items, including carbohydrate, fat, protein, dairy products, fish, meat, fruit and vegetables, energy, fibre, alcohol, lycopene and selenium. Cases were matched on age and diary date to at least one control within study (n=3528). Prostate cancer risk was calculated, using conditional logistic regression (adjusted for baseline covariates) and expressed as odds ratios in each quintile of intake (±95% confidence intervals). Prostate cancer risk was also investigated by localised or advanced stage and by cancer detection method. RESULTS There were no strong associations between prostate cancer risk and 37 dietary factors. CONCLUSIONS Prostate cancer risk, including by disease stage, was not strongly associated with dietary factors measured by food diaries in middle-aged and older UK men.
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Affiliation(s)
- J A Lane
- School of Social and Community Medicine, University of Bristol Bristol, UK
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, Level 3, University Hospitals Bristol Education Centre, Bristol, UK
| | - S E Oliver
- University of York and Hull York Medical School, York, UK
| | - P N Appleby
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M A H Lentjes
- Medical Research Council Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Cambridge, UK
| | - P Emmett
- School of Social and Community Medicine, University of Bristol Bristol, UK
| | - D Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - A Stephen
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
- Department of Nutritional Sciences, University of Surrey, Guildford, Surrey, UK
| | - E J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - M J Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - F C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - D E Neal
- Cambridge University and Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - J L Donovan
- School of Social and Community Medicine, University of Bristol Bristol, UK
| | - K-T Khaw
- Medical Research Council Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Brewster DH, Fischbacher CM, Nolan J, Nowell S, Redpath D, Nabi G. Risk of hospitalization and death following prostate biopsy in Scotland. Public Health 2017; 142:102-110. [PMID: 27810089 PMCID: PMC5226055 DOI: 10.1016/j.puhe.2016.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/22/2016] [Accepted: 10/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the risk of hospitalization and death following prostate biopsy. STUDY DESIGN Retrospective cohort study. METHODS Our study population comprised 10,285 patients with a record of first ever prostate biopsy between 2009 and 2013 on computerized acute hospital discharge or outpatient records covering Scotland. Using the general population as a comparison group, expected numbers of admissions/deaths were derived by applying age-, sex-, deprivation category-, and calendar year-specific rates of hospital admissions/deaths to the study population. Indirectly standardized hospital admission ratios (SHRs) and mortality ratios (SMRs) were calculated by dividing the observed numbers of admissions/deaths by expected numbers. RESULTS Compared with background rates, patients were more likely to be admitted to hospital within 30 days (SHR 2.7; 95% confidence interval 2.4, 2.9) and 120 days (SHR 4.0; 3.8, 4.1) of biopsy. Patients with prior co-morbidity had higher SHRs. The risk of death within 30 days of biopsy was not increased significantly (SMR 1.6; 0.9, 2.7), but within 120 days, the risk of death was significantly higher than expected (SMR 1.9; 1.5, 2.4). The risk of death increased with age and tended to be higher among patients with prior co-morbidity. Overall risks of hospitalization and of death up to 120 days were increased both in men diagnosed and those not diagnosed with prostate cancer. CONCLUSIONS Higher rates of adverse events in older patients and patients with prior co-morbidity emphasizes the need for careful patient selection for prostate biopsy and justifies ongoing efforts to minimize the risk of complications.
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Affiliation(s)
- D H Brewster
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK; Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
| | - C M Fischbacher
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK; Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - J Nolan
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK
| | - S Nowell
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK
| | - D Redpath
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK
| | - G Nabi
- Section of Academic Urology, Cancer Research Division, School of Medicine, Ninewells Hospital, Dundee, Scotland, UK; Department of Surgical Urology, Ninewells Hospital, NHS Tayside, Dundee, Scotland, UK
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Littlejohns TJ, Travis RC, Key TJ, Allen NE. Lifestyle factors and prostate-specific antigen (PSA) testing in UK Biobank: Implications for epidemiological research. Cancer Epidemiol 2016; 45:40-46. [PMID: 27693812 PMCID: PMC5147810 DOI: 10.1016/j.canep.2016.09.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The central role of prostate-specific antigen (PSA) testing in the diagnosis of prostate cancer leads to the possibility that observational studies that report associations between risk factors and prostate cancer could be affected by detection bias. This study aims to investigate whether reported risk factors for prostate cancer are associated with PSA testing in a large middle-aged population-based cohort in the UK. METHODS The cross-sectional association between a wide range of sociodemographic, lifestyle, dietary and health characteristics with PSA testing was examined in 212,039 men aged 40-69 years in UK Biobank. RESULTS A total of 62,022 (29%) men reported they had ever had a PSA test. A wide range of factors was associated with a higher likelihood of PSA testing including age, height, education level, family history of prostate cancer, black ethnic origin, not being in paid/self-employment, living with a wife or partner, having had a vasectomy, being diagnosed with cancer or hypertension and having a high dietary intake of cereal, cooked and salad/raw vegetables, fresh fruit and tea. Conversely, socioeconomic deprivation, Asian ethnic origin, current smoking, low alcohol intake, high body-mass index, high coffee consumption and being diagnosed with diabetes, heart disease or stroke were associated with a lower likelihood of PSA testing. CONCLUSIONS A variety of sociodemographic, lifestyle and health-related characteristics are associated with PSA testing, suggesting that observed associations of some of these traits with risk for prostate cancer in epidemiological studies may be, at least partially, due to detection bias.
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Affiliation(s)
- Thomas J Littlejohns
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Tim J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
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11
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Walsh EI, Turner EL, Lane JA, Donovan JL, Neal DE, Hamdy FC, Martin RM. Characteristics of men responding to an invitation to undergo testing for prostate cancer as part of a randomised trial. Trials 2016; 17:497. [PMID: 27737692 PMCID: PMC5064919 DOI: 10.1186/s13063-016-1624-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sociodemographic characteristics are associated with participating in cancer screening and trials. We compared the characteristics of those responding with those not responding to a single invitation for prostate-specific antigen (PSA) testing for prostate cancer as part of the Cluster randomised triAl of PSA testing for Prostate cancer (CAP). METHODS Age, rurality and deprivation among 197,763 men from 271 cluster-randomised primary care centres in the UK were compared between those responding (n = 90,300) and those not responding (n = 100,953) to a prostate cancer testing invitation. RESULTS There was little difference in age between responders and nonresponders. Responders were slightly more likely to come from urban rather than rural areas and were slightly less deprived than those who did not respond. CONCLUSION These data indicate similarities in age and only minor differences in deprivation and urban location between responders and nonresponders. These differences were smaller, but in the same direction as those observed in other screening trials. TRIAL REGISTRATION ISRCTN92187251 . Registered on 29 November 2004.
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Affiliation(s)
- Eleanor I. Walsh
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Emma L. Turner
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - J. Athene Lane
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jenny L. Donovan
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David E. Neal
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Freddie C. Hamdy
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Richard M. Martin
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - and the CAP & ProtecT Trial Groups
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, OX3 9DU UK
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12
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Thomas AA, Pearce A, Sharp L, Gardiner RA, Chambers S, Aitken J, Molcho M, Baade P. Socioeconomic disadvantage but not remoteness affects short-term survival in prostate cancer: A population-based study using competing risks. Asia Pac J Clin Oncol 2016; 13:e31-e40. [DOI: 10.1111/ajco.12570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/24/2015] [Accepted: 11/30/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Audrey A Thomas
- Health Promotion Research Centre; National University of Ireland; Galway Ireland
| | | | - Linda Sharp
- Institute of Health and Society; Newcastle University; United Kingdom
| | | | - Suzanne Chambers
- Menzies Health Institute Queensland; Griffith University; Gold Coast Australia
| | | | - Michal Molcho
- Department of Health Promotion; National University of Ireland; Galway Ireland
| | - Peter Baade
- Cancer Council Queensland; Brisbane Australia
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13
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Moss S, Melia J, Sutton J, Mathews C, Kirby M. Prostate-specific antigen testing rates and referral patterns from general practice data in England. Int J Clin Pract 2016; 70:312-8. [PMID: 26987766 DOI: 10.1111/ijcp.12784] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is currently no national screening programme for prostate cancer in England, but eligible men can request a prostate-specific antigen (PSA) test from their general practitioner (GP). There are no routinely available data to monitor the extent of PSA testing and referral. AIM The aim of this study was to investigate the rate of PSA testing in general practice and subsequent patterns of referral. DESIGN AND SETTING Data obtained from the Clinical Practice Research Datalink (CPRD) for men aged 45-84 years who had a PSA test during 2010-2011, registered in practices in England with linked Hospital Episode Statistics (HES) data. METHOD Patient data were linked to previous tests and consultations. Rates of PSA testing and proportions of men retested and referred to secondary care were calculated. RESULTS Overall, 8.74 (95% CI 8.67-8.82) of men per 100 person-years were tested at least once in 2010, and 9.45 (95% CI 9.37-9.53) in 2011. Rates increased with age and decreased with increasing level of deprivation. Of the 53,069 men tested in 2010, 11,289 (21.3%) had a previous PSA test within the past 12 months. Of men with raised PSA according to age specific guidelines, 22.4% (2113/9425) were referred to secondary care within 14 days, with 36% of the remainder retested within 6 months. CONCLUSIONS Rates of PSA testing have increased compared with earlier studies; the data suggest that many GPs are retesting men with raised PSA rather than referring immediately. More routine data on PSA testing, including reasons for testing, and subsequent management and outcomes, are required.
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Affiliation(s)
- S Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - J Melia
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - J Sutton
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Mathews
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - M Kirby
- Faculty of Health and Human Sciences, University of Hertfordshire and the Prostate Centre, London, UK
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14
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Thomsen FB, Folkvaljon Y, Garmo H, Robinson D, Loeb S, Ingvar C, Lambe M, Stattin P. Risk of malignant melanoma in men with prostate cancer: Nationwide, population-based cohort study. Int J Cancer 2016; 138:2154-60. [DOI: 10.1002/ijc.29961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/18/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Frederik B. Thomsen
- Department of Urology; Bispebjerg and Frederiksberg Hospital; Frederiksberg Denmark
| | - Yasin Folkvaljon
- Regional Cancer Centre, Uppsala/Örebro, Uppsala University Hospital; Uppsala Sweden
| | - Hans Garmo
- King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group; London United Kingdom
| | - David Robinson
- Department of Surgical and Perioperative Sciences; Urology and Andrology, Umeå University; Umeå Sweden
- Department of Urology; Ryhov Hospital; Jönköping Sweden
| | - Stacy Loeb
- Department of Urology; Population Health and the Laura and Isaac Perlmutter Cancer Institute, New York University and Manhattan Veterans Affairs Medical Center; New York NY
| | - Christian Ingvar
- Department of Surgery; Clinical Sciences, Lund University, Skåne University Hospital; Lund Sweden
| | - Mats Lambe
- Regional Cancer Centre, Uppsala/Örebro, Uppsala University Hospital; Uppsala Sweden
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences; Urology and Andrology, Umeå University; Umeå Sweden
- Department of Urology; Uppsala University Hospital; Uppsala Sweden
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15
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Guessous I, Cullati S, Fedewa SA, Burton-Jeangros C, Courvoisier DS, Manor O, Bouchardy C. Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparities. Prev Med 2016; 82:83-91. [PMID: 26582208 DOI: 10.1016/j.ypmed.2015.11.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite important controversy in its efficacy, prostate cancer (PCa) screening has become widespread. Important socioeconomic screening disparities have been reported. However, trends in PCa screening and social disparities have not been investigated in Switzerland, a high risk country for PCa. We used data from five waves (from 1992-2012) of the population-based Swiss Health Interview Survey to evaluate trends in PCa screening and its association with socioeconomic indicators. METHODS We used multivariable Poisson regression to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and use of healthcare. RESULTS The study included 12,034 men aged ≥50 years (mean age: 63.9). Between 1992 and 2012, ever use of PCa screening increased from 55.3% to 70.0% and its use within the last two years from 32.6% to 42.4% (p-value <0.05). Income, education, and occupational class were independently associated with PCa screening. PCa screening within the last two years was greater in men with the highest (>$6,000/month) vs. lowest income (≤$2,000) (46.5% vs. 38.7% in 2012, PR for overall period =1.29, 95%CI: 1.13-1.48). These socioeconomic disparities did not significantly change over time. CONCLUSIONS This study shows that about half of Swiss men had performed at least one PCa screening. Men belonging to high socioeconomic status are clearly more frequently screened than those less favored. Given the uncertainty of the usefulness of PCa screening, men, including those with high socioeconomic status, should be clearly informed about benefits and harms of PCa screening, in particular, the adverse effect of over-diagnosis and of associated over-treatment.
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Affiliation(s)
- Idris Guessous
- Unit of population epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland; Emory University, Department of Epidemiology, Atlanta, GA, USA; Division of chronic diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Stéphane Cullati
- Unit of population epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Stacey A Fedewa
- Emory University, Department of Epidemiology, Atlanta, GA, USA; American Cancer Society, Atlanta, GA, USA
| | | | | | - Orly Manor
- School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - Christine Bouchardy
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland
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16
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Nordström T, Bratt O, Örtegren J, Aly M, Adolfsson J, Grönberg H. A population-based study on the association between educational length, prostate-specific antigen testing and use of prostate biopsies. Scand J Urol 2015; 50:104-9. [PMID: 26625178 DOI: 10.3109/21681805.2015.1113200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether educational length affects prostate-specific antigen (PSA) testing and the time to prostate biopsy for men with raised PSA values. MATERIALS AND METHODS Using register data on all men in Stockholm County in 2013 (n = 1,052,841), the limited-duration point prevalence of PSA testing and time between test and prostate biopsy or repeat testing were analysed. Patterns of follow-up were assessed using Kaplan-Meier product limit estimators and Cox proportional hazard models. Educational length was categorized as short (≤ 9 years), intermediate (10-12 years) or long (≥ 13 years). RESULTS PSA testing increased with educational length in all age groups. Among men aged 50-69 years, 61% with long and 54% with short education had had a PSA test within the preceding 10 years (p < 0.001). In men with PSA 4-10 ng/ml, 40% [95% confidence interval (CI) 38-41] with long and 27% (95% CI 26-29) with short education underwent a prostate biopsy within 12 months. After adjusting for PSA level and age, educational length was still associated with the chance of having a prostate biopsy in men with PSA 4-10 ng/ml (hazard ratio 1.22, 95% CI 1.12-1.31), but not in men with higher PSA values. CONCLUSION PSA testing increased with educational length. Men with long education were more likely to have a prostate biopsy after an increased PSA value below 10 ng/ml than men with short education. These differences may contribute to the worse prostate cancer outcomes observed among men with lower socioeconomic status.
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Affiliation(s)
- Tobias Nordström
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden ;,b Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden ;,c Department of Urology , Helen Diller Family Comprehensive Cancer Center, University of California , San Francisco , CA , USA
| | - Ola Bratt
- d Urological Cancer Research Unit, Department of Translational Medicine , Lund University , Lund , Sweden ;,e Department of Urology , Cambridge University Hospitals , Cambridge , UK
| | - Joakim Örtegren
- d Urological Cancer Research Unit, Department of Translational Medicine , Lund University , Lund , Sweden
| | - Markus Aly
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Jan Adolfsson
- f Karolinska Institutet , Department of Clinical Science, Intervention and Technology (CLINTEC) , Stockholm , Sweden ;,g Swedish Council for Health Technology Assessment , Stockholm , Sweden
| | - Henrik Grönberg
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
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17
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Pacheco-Figueiredo L, Antunes L, Bento MJ, Lunet N. Incidence of second primary cancers in North Portugal—a population-based study. J Cancer Surviv 2015; 10:142-52. [DOI: 10.1007/s11764-015-0460-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 05/22/2015] [Indexed: 12/24/2022]
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18
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Baade PD, Yu XQ, Smith DP, Dunn J, Chambers SK. Geographic Disparities in Prostate Cancer Outcomes - Review of International Patterns. Asian Pac J Cancer Prev 2015; 16:1259-75. [DOI: 10.7314/apjcp.2015.16.3.1259] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Vicens GR, Zafra MS, Moreno-Crespi J, Ferrer BCS, Marcos-Gragera R. Incidence variation of prostate and cervical cancer according to socioeconomic level in the Girona Health Region. BMC Public Health 2014; 14:1079. [PMID: 25325921 PMCID: PMC4287549 DOI: 10.1186/1471-2458-14-1079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/05/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The main aim of this study, using a spatial-temporal model, is to analyse the link between a deprivation index and the incidence of prostate and cervical cancer in the Girona Health Region (GHR). METHODS This is a population-based study which includes all the inhabitants in the GHR in the period 1993-2006. In order to assess prostate/cervical cancer risk, Besag, York and Mollie (BYM)'s spatial-temporal version of the model was used and four random effects were introduced: (non-spatial) unstructured variability, spatial dependency, temporal dependency and spatial-temporal interaction. As an explanatory variable, a deprivation index was introduced at the census tract level. Furthermore, the percentage of the population between 45-64 years of age and over-65 was also considered as explanatory variables. RESULTS In the case of prostate cancer, all the variables which were introduced into the model showed a significant correlation with the relative risk, except for the second quintile of the deprivation index. Furthermore, as the index increased the correlation became negative and lower. Thus, the correlation between the relative risk and the two age bands proved to be lower, the higher the age was. In the case of cervical cancer, only the correlation between the over-65 age band and the relative risk was found to be statistically significant and positive. CONCLUSIONS In the case of prostate cancer, the results obtained in the GHR are in line with similar analyses. However, in the case of cervical cancer, no significant relationship between incidences in this location or economic status was found.
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Affiliation(s)
- Gemma Renart Vicens
- />Research Group on Statistics, Applied Economics and Health (GRECS), CIBER of Epidemiology and Public Health (CIBERESP), University of Girona, Campus de Montilivi, Girona, 17071 Spain
| | - Marc Saez Zafra
- />Research Group on Statistics, Applied Economics and Health (GRECS), CIBER of Epidemiology and Public Health (CIBERESP), University of Girona, Campus de Montilivi, Girona, 17071 Spain
| | - Judit Moreno-Crespi
- />Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute, Girona, Spain
| | - Bernat C Serdà Ferrer
- />Departament d’Infermeria. Universitat de Girona (UdG), Girona Biomedical Research Institute, Girona, Spain
| | - Rafael Marcos-Gragera
- />Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute, Girona, Spain
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20
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A systematic review and meta-analysis of tobacco use and prostate cancer mortality and incidence in prospective cohort studies. Eur Urol 2014; 66:1054-64. [PMID: 25242554 DOI: 10.1016/j.eururo.2014.08.059] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/25/2014] [Indexed: 12/13/2022]
Abstract
CONTEXT An association between tobacco smoking and prostate cancer (PCa) incidence and mortality was suggested in an earlier meta-analysis of 24 prospective studies in which dose-response associations and risks per unit of tobacco use were not examined. OBJECTIVE We investigated the association between several measures of tobacco use and PCa mortality (primary outcome) and incidence (secondary outcome) including dose-response association. EVIDENCE ACQUISITION Relevant articles from prospective studies were identified by searching the PubMed and Web of Science databases (through January 21, 2014) and reference lists of relevant articles. Combined relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects methods. We also calculated population attributable risk (PAR) for smoking and PCa mortality. EVIDENCE SYNTHESIS We included 51 articles in this meta-analysis (11823 PCa deaths, 50349 incident cases, and 4,082,606 cohort participants). Current cigarette smoking was associated with an increased risk of PCa death (RR: 1.24; 95% CI, 1.18-1.31), with little evidence for heterogeneity and publication bias. The number of cigarettes smoked per day had a dose-response association with PCa mortality (p=0.02; RR for 20 cigarettes per day: 1.20). The PAR for cigarette smoking and PCa deaths in the United States and Europe were 6.7% and 9.5%, respectively, corresponding to >10000 deaths/year in these two regions. Current cigarette smoking was inversely associated with incident PCa (RR: 0.90; 95% CI, 0.85-0.96), with high heterogeneity in the results. However, in studies completed in 1995 or earlier (considered as completed before the prostate-specific antigen screening era), ever smoking showed a positive association with incident PCa (RR: 1.06; 95% CI, 1.00-1.12) with little heterogeneity. CONCLUSIONS Combined evidence from observational studies shows a modest but statistically significant association between cigarette smoking and fatal PCa. Smoking appears to be a modifiable risk factor for PCa death. PATIENT SUMMARY Smoking increases the chance of prostate cancer death. Not smoking prevents this harm and many other tobacco-related diseases.
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21
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Papa N, Lawrentschuk N, Muller D, MacInnis R, Ta A, Severi G, Millar J, Syme R, Giles G, Bolton D. Rural residency and prostate cancer specific mortality: results from the Victorian Radical Prostatectomy Register. Aust N Z J Public Health 2014; 38:449-54. [DOI: 10.1111/1753-6405.12210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 10/01/2013] [Accepted: 01/01/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nathan Papa
- Austin Hospital, Victoria
- Cancer Epidemiology Centre, Cancer Council Victoria
| | | | - David Muller
- Cancer Epidemiology Centre, Cancer Council Victoria
| | | | | | | | | | | | - Graham Giles
- Cancer Epidemiology Centre, Cancer Council Victoria
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22
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Mehta R, Gillan AS, Ming ZY, Rai BP, Byrne D, Nabi G. Socio-economic deprivation and outcomes following radical nephroureterectomy for clinically localized upper tract transitional cell carcinoma. World J Urol 2014; 33:41-9. [PMID: 24619009 DOI: 10.1007/s00345-014-1262-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 02/10/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Little is known about the effects of socio-economic deprivation on the oncological outcomes of surgically treated upper tract transitional cell carcinoma. METHODS From January 1998 to December 2012, 161 patients underwent nephroureterectomy for upper urinary tract cancer at our tertiary medical centre. We included 124 patients where complete data were available for further analysis. This study also analysed the impact of the reported risk factors such as grade, stage, multifocality in addition to socio-economic deprivation on the long-term oncological outcomes after nephroureterectomy. RESULTS One hundred and twenty-four (77 %) patients with complete data for socio-economic status were analysed in this study. The median age of the cohort was 73 years (interquartile range 45-86). There were 20, 18, 17, 40 and 29 patients in different socio-economic categories ranging from 1 to 5, respectively. The median duration of follow-up was 68 months (9-174). A statistically higher grade (p value 0.005) and higher stage (p value 0.0005) disease was seen in patients from less deprived categories on both univariate and multivariate analyses. The cancer-specific mortality and follow-up recurrences, however, did not significantly differ between the different socio-economic categories on multivariate analysis (p value 0.13; 0.6) and on univariate and multivariate analyses. A higher number of patients with multifocal disease and concomitant carcinoma in situ (CIS) had disease recurrences which were statistically significant (p values 0.026 and 0.014, respectively) on multivariate analysis. CONCLUSIONS A lower recurrence-free survival was observed in patients with multifocal disease and those with concomitant CIS following nephroureterectomy for clinically localized disease. Long-term follow-up did not show any significant differences in cancer-specific survival between different deprivation categories.
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Affiliation(s)
- R Mehta
- Academic Section of Urology, Division of Imaging and Technology, Medical Research Institute, Medical School, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, Scotland, UK,
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