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Wu J, Bai Y, Lu Y, Yu Z, Zhang S, Yu B, Chen L, Li J. Role of sex steroids in colorectal cancer: pathomechanisms and medical applications. Am J Cancer Res 2024; 14:3200-3221. [PMID: 39113870 PMCID: PMC11301278 DOI: 10.62347/oebs6893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/26/2024] [Indexed: 08/10/2024] Open
Abstract
Given that the colon represents the most extensive hormone-responsive tissue in the human body, it prompts a compelling inquiry into whether the progression of its cancer is intimately linked to hormonal dynamics. Consequently, the interplay between sex steroids - a pivotal constituent of hormones - and colorectal cancer has increasingly captivated scientific interest. Upon a comprehensive review of pertinent literature both domestically and internationally, this study delineates the present landscape of three pivotal steroids - estrogen, progestin, and androgen - in the context of colorectal cancer. More specifically, this investigation probes into the potential utility of these steroids in providing therapeutic interventions, diagnostic insights, and prognostic indicators. Furthermore, this study also delves into the mechanistic pathways through which sex steroid interventions exert influence on colorectal cancer. It was discovered that the trio of sex steroid hormones partakes in an array of biological processes, thereby influencing the onset and progression of colorectal cancer. In conclusion, this study posits that a profound interconnection exists between colorectal cancer and sex steroids, suggesting that elucidating the targets of their action mechanisms could unveil novel avenues for the diagnosis and prevention of colorectal cancer.
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Affiliation(s)
- Jianglan Wu
- Hunan University of Traditional Chinese MedicineChangsha 410208, Hunan, China
| | - Yanan Bai
- Hunan University of Traditional Chinese MedicineChangsha 410208, Hunan, China
| | - Yuwen Lu
- Hunan University of Traditional Chinese MedicineChangsha 410208, Hunan, China
| | - Zixuan Yu
- Hunan University of Traditional Chinese MedicineChangsha 410208, Hunan, China
| | - Shumeng Zhang
- Hunan University of Traditional Chinese MedicineChangsha 410208, Hunan, China
| | - Bin Yu
- Department of Gastroenterology, The First Affiliated Hospital of Hunan University of Traditional Chinese MedicineChangsha 410007, Hunan, China
| | - Lingli Chen
- Hunan Provincial Key Laboratory of Pathogenic Biology Based on Integrated Chinese and Western Medicine, Hunan University of Traditional Chinese MedicineChangsha 410208, Hunan, China
| | - Jie Li
- Hunan University of Traditional Chinese MedicineChangsha 410208, Hunan, China
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Møller M, Kjær SK, Lindquist S, Brown Frandsen CL, Albieri V, Viuff JH, Nøhr B, Olsen A, Jensen A. Risk of colorectal cancer after use of fertility drugs-results from a large Danish population-based cohort of women with infertility. Fertil Steril 2022; 118:738-747. [PMID: 36041966 DOI: 10.1016/j.fertnstert.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To study the association between use of fertility drugs and colorectal cancer among women with infertility. DESIGN Population-based cohort study. SETTING Not applicable. PATIENT(S) The study cohort was obtained from the Danish Infertility Cohort and consisted of all women with infertility aged 20-45 years living in Denmark during 1995-2017. INTERVENTION(S) Information on the use of specific types of fertility drugs, colorectal cancer diagnoses, covariates, and vital status were obtained from the Danish Infertility Cohort and Danish national registers. MAIN OUTCOME MEASURE(S) Cox proportional hazard models adjusted for potential confounders were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for colorectal cancer overall and rectal and colon cancer separately. RESULTS(S) Among 148,036 women in the final study cohort, 205 women were diagnosed with colorectal cancer. Ever use of clomiphene citrate (CC) was associated with a lower rate of colorectal cancer (unadjusted HR, 0.67; 95% CI, 0.51-0.89; adjusted HR, 0.68; 95% CI, 0.50-0.93). However, the lower rate was only seen among women who first used CC >8 years ago (unadjusted HR, 0.56; 95% CI, 0.41-0.76; adjusted HR, 0.52; 95% CI, 0.36-0.75). No marked associations were found between the use of any of other types of fertility drugs and colorectal cancer. The results for colon and rectal cancer analyzed separately were similar, except for a suggestion of a decreased risk of rectal cancer associated with the use of gonadotropins (adjusted HR, 0.46; 95% CI, 0.20-1.08). CONCLUSION(S) Among women with infertility, the use of most types of fertility drugs was not associated with colorectal cancer. However, CC may decrease the risk of colorectal cancer and gonadotropins might decrease the risk of rectal cancer, but we cannot rule out that these findings may be more related to the underlying conditions in these women or are chance findings. Consequently, the results from this study should be investigated further in large epidemiological studies.
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Affiliation(s)
- Maria Møller
- Lifestyle, Reproduction and Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Lindquist
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Vanna Albieri
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jakob Hansen Viuff
- Diet, Cancer and Health, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Bugge Nøhr
- The Fertility Clinic, Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Anja Olsen
- Nutrition and Biomarkers, Danish Cancer Society Reseach Center, Copenhagen, Denmark; Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Allan Jensen
- Lifestyle, Reproduction and Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.
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Amitay EL, Niedermaier T, Alwers E, Chang-Claude J, Hoffmeister M, Brenner H. Reproductive factors and colorectal cancer risk: A Population-based case-control study. JNCI Cancer Spectr 2022; 6:6596622. [PMID: 35642982 PMCID: PMC9251386 DOI: 10.1093/jncics/pkac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/06/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hormone-replacement therapy (HRT) is associated with lower colorectal cancer (CRC) risk among postmenopausal women. However, little is known about the effects of lifetime exposure of women to varying levels of estrogen and progesterone through reproductive factors such as parity, use of oral contraceptives (OC), breastfeeding, and menstruation on CRC risk. Methods We assessed associations between reproductive factors and CRC risk among 2650 female CRC patients aged 30+ years and 2175 matched controls in a population-based study in Germany, adjusting for potential confounders by multiple logistic regression. Results Inverse associations with CRC risk were found for numbers of pregnancies (odds ratio [OR] per pregnancy = 0.91, 95% confidence interval [CI] = 0.86 to 0.97), breastfeeding for 12 months and longer (OR = 0.74, 95% CI = 0.61 to 0.90), and use of either OC or HRT (OR = 0.75, 95% CI = 0.64 to 0.87) or both (OR = 0.58, 95% CI = 0.48 to 0.70). Similar results were found for postmenopausal women only and when adjusting for number of pregnancies and for all reproductive factors analyzed together. Breastfeeding duration of 12 months and longer was associated with lower risk of cancer only in the proximal colon (OR = 0.58, 95% CI = 0.45 to 0.74). Conclusions Several reproductive factors were associated with lower CRC risk in women, including number of pregnancies, breastfeeding duration, and use of OC and HRT. This suggests that women’s exposure to female reproductive hormones plays a key role in the difference in CRC risk between women and men and in site-specific CRC risk.
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Affiliation(s)
- Efrat L Amitay
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elizabeth Alwers
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Genetic Tumor Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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4
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Brabaharan S, Veettil SK, Kaiser JE, Raja Rao VR, Wattanayingcharoenchai R, Maharajan M, Insin P, Talungchit P, Anothaisintawee T, Thakkinstian A, Chaiyakunapruk N. Association of Hormonal Contraceptive Use With Adverse Health Outcomes: An Umbrella Review of Meta-analyses of Randomized Clinical Trials and Cohort Studies. JAMA Netw Open 2022; 5:e2143730. [PMID: 35029663 PMCID: PMC8760614 DOI: 10.1001/jamanetworkopen.2021.43730] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Meta-analyses have reported conflicting data on the safety of hormonal contraception, but the quality of evidence for the associations between hormonal contraceptive use and adverse health outcomes has not been quantified in aggregate. OBJECTIVE To grade the evidence from meta-analyses of randomized clinical trials (RCTs) and cohort studies that assessed the associations between hormonal contraceptive use and adverse health outcomes among women. DATA SOURCES MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched from database inception to August 2020. Search terms included hormonal contraception, contraceptive agents, progesterone, desogestrel, norethindrone, megestrol, algestone, norprogesterones, and levonorgestrel combined with terms such as systematic review or meta-analysis. EVIDENCE REVIEW The methodological quality of each meta-analysis was graded using the Assessment of Multiple Systematic Reviews, version 2, which rated quality as critically low, low, moderate, or high. The Grading of Recommendation, Assessment, Development and Evaluations approach was used to assess the certainty of evidence in meta-analyses of RCTs, with evidence graded as very low, low, moderate, or high. Evidence of associations from meta-analyses of cohort studies was ranked according to established criteria as nonsignificant, weak, suggestive, highly suggestive, or convincing. RESULTS A total of 2996 records were screened; of those, 310 full-text articles were assessed for eligibility, and 58 articles (13 meta-analyses of RCTs and 45 meta-analyses of cohort studies) were selected for evidence synthesis. Sixty associations were described in meta-analyses of RCTs, and 96 associations were described in meta-analyses of cohort studies. Among meta-analyses of RCTs, 14 of the 60 associations were nominally statistically significant (P ≤ .05); no associations between hormonal contraceptive use and adverse outcomes were supported by high-quality evidence. The association between the use of a levonorgestrel-releasing intrauterine system and reductions in endometrial polyps associated with tamoxifen use (odds ratio [OR], 0.22; 95% CI, 0.13-0.38) was graded as having high-quality evidence, and this evidence ranking was retained in the subgroup analysis. Among meta-analyses of cohort studies, 40 of the 96 associations were nominally statistically significant; however, no associations between hormonal contraceptive use and adverse outcomes were supported by convincing evidence in the primary and subgroup analyses. The risk of venous thromboembolism among those using vs not using oral contraception (OR, 2.42; 95% CI, 1.76-3.32) was initially supported by highly suggestive evidence, but this evidence was downgraded to weak in the sensitivity analysis. CONCLUSIONS AND RELEVANCE The results of this umbrella review supported preexisting understandings of the risks and benefits associated with hormonal contraceptive use. Overall, the associations between hormonal contraceptive use and cardiovascular risk, cancer risk, and other major adverse health outcomes were not supported by high-quality evidence.
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Affiliation(s)
- Sharmila Brabaharan
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Sajesh K. Veettil
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City
| | - Jennifer E. Kaiser
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City
| | | | - Rujira Wattanayingcharoenchai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Marikannan Maharajan
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Putsarat Insin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
| | - Pattarawalai Talungchit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City
- School of Pharmacy, University of Wisconsin–Madison, Madison
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Abstract
Females differ from males in incidence and clinical characteristics of colorectal cancer. Understanding the differences can lead to development of preventive approaches. To identify reproductive factors currently associated with the risk of colorectal cancer. Consecutively diagnosed female colorectal cancer cases and randomly chosen colorectal cancer-free controls matched on age/ethnicity/primary care clinic within the molecular epidemiology of colorectal cancer study, a population-based case-control study in Northern Israel, were included. A total of 2867 female cases and 2333 controls participated in this analysis. Participants were interviewed on reproductive history: ages at menarche, menopause, first birth, terminations of pregnancies, miscarriages, births, use of oral contraceptives. Among 5200 women, spontaneous miscarriages (odds ratio = 0.71, 0.61-0.83 for ever/never in Jews; odds ratio = 0.76, 0.53-1.08 in Arabs) and number of miscarriages, but not termination of pregnancies, as well as use, and duration of use, of oral contraceptives (Jews: odds ratio = 0.49, 0.39-0.62 for ever/never; Arabs: odds ratio = 0.14, 0.04-0.47) were strongly inversely associated with colorectal cancer risk. Up to 5 pregnancies were associated with increased risk while ages at menarche, at menopause and at first birth were not associated with colorectal cancer risk. Miscarriages but not terminations of pregnancy or full-term pregnancies, and use of oral contraceptives, were strongly associated with reduced odds of developing colorectal cancer suggesting unique hormonal influences on colorectal cancer.
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Cornish AJ, Tomlinson IPM, Houlston RS. Mendelian randomisation: A powerful and inexpensive method for identifying and excluding non-genetic risk factors for colorectal cancer. Mol Aspects Med 2019; 69:41-47. [PMID: 30710596 PMCID: PMC6856712 DOI: 10.1016/j.mam.2019.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer in economically developed countries and a major cause of cancer-related mortality. The importance of lifestyle and diet as major determinants of CRC risk is suggested by differences in CRC incidence between countries and in migration studies. Previous observational epidemiological studies have identified associations between modifiable environmental risk factors and CRC, but these studies can be susceptible to reverse causation and confounding, and their results can therefore conflict. Mendelian randomisation (MR) analysis represents an approach complementary to conventional observational studies examining associations between exposures and disease. The MR strategy employs allelic variants as instrumental variables (IVs), which act as proxies for non-genetic exposures. These allelic variants are randomly assigned during meiosis and can therefore inform on life-long exposure, whilst not being subject to reverse causation. In previous studies MR frameworks have associated several modifiable factors with CRC risk, including adiposity, hyperlipidaemia, fatty acid profile and alcohol consumption. In this review we detail the use of MR to investigate and discover CRC risk factors, and its future applications.
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Affiliation(s)
- Alex J Cornish
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
| | - Ian P M Tomlinson
- Cancer Genetics and Evolution Laboratory, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Department of Histopathology, University Hospitals Birmingham, Birmingham, UK
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Division of Molecular Pathology, The Institute of Cancer Research, London, UK
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7
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Jung Y. Female hormones and the risk of colorectal neoplasm. Korean J Intern Med 2019; 34:982-984. [PMID: 31466433 PMCID: PMC6718757 DOI: 10.3904/kjim.2019.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/14/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yunho Jung
- Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Correspondence to Yunho Jung, M.D. Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea Tel: +82-41-570-3741 Fax: +82-41-574-5762 E-mail:
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Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman WV, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM. No. 329-Canadian Contraception Consensus Part 4 of 4 Chapter 9: Combined Hormonal Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:229-268.e5. [PMID: 28413042 DOI: 10.1016/j.jogc.2016.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. OUTCOMES Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, safety, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the availability of cited contraceptive methods in Canada. EVIDENCE Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1994 to December 2015 in order to update the Canadian Contraception Consensus published February-April 2004. Relevant Canadian government publications and position papers from appropriate health and family planning organizations were also reviewed. VALUES The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice are ranked according to the method described in this report. SUMMARY STATEMENTS RECOMMENDATIONS.
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Williams WV, Mitchell LA, Carlson SK, Raviele KM. Association of Combined Estrogen-Progestogen and Progestogen-Only Contraceptives with the Development of Cancer. LINACRE QUARTERLY 2019; 85:412-452. [PMID: 32431377 DOI: 10.1177/0024363918811637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Combined estrogen-progestogen contraceptives (oral contraceptives or OCs) and progestogen-only contraceptives (POCs) are synthetic steroids that bind to steroid hormone receptors, which are widespread throughout the body. They have a profound effect on cellular physiology. Combined OCs have been classified by the International Agency for Research on Cancer (IARC) as Group 1 carcinogens, but their findings have not been updated recently. In order to update the information and better understand the impact that OCs and POCs have on the risk of development of cancers, a comprehensive literature search was undertaken, focusing on more recently published papers. In agreement with the IARC, the recent literature confirms an increased risk of breast cancer and cervical cancer with the use of OCs. The recent literature also confirms the IARC conclusion that OCs decrease the risk of ovarian and endometrial cancers. However, there is little support from recent studies for the IARC conclusion that OCs decrease the risk of colorectal cancer or increase the risk of liver cancer. For liver cancer, this may be due to the recent studies having been performed in areas where hepatitis is endemic. In one large observational study, POCs also appear to increase the overall risk of developing cancer. OCs and POCs appear to increase the overall risk of cancer when carefully performed studies with the least intrinsic bias are considered. Summary OCs have been classified as cancer-causing agents, especially leading to increases in breast cancer and cervical cancer. A review of the recent scientific literature was performed to see whether this still appears to be the case. The recent literature supports the cancer-causing role of OCs especially for breast cancer and cervical cancer. Studies also indicate that progesterone-only contraceptives (such as implants and vaginal rings) also can cause cancer. This is especially true for breast cancer and cervical cancer.
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Affiliation(s)
- William V Williams
- BriaCell Therapeutics Corporation, West Vancouver, British Columbia, Canada.,University of Pennsylvania, Philadelphia, PA, USA
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10
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Reproductive factors, obesity and risk of colorectal cancer in a cohort of Asian women. Cancer Epidemiol 2018; 58:33-43. [PMID: 30448606 DOI: 10.1016/j.canep.2018.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study evaluated reproductive factors and obesity in relation to colorectal cancer (CRC) in Asian women. METHODS The study cohort comprised 28191 women who were recruited between 1994 and 1997. During 18 years of prospective follow-up, 404 and 212 women developed colon cancer (CC) and rectal cancer (RC) respectively. Cox proportional hazards regression was used. RESULTS Menstrual factors were not related to the risk of CRC, CC and RC. Gravidity and parity were not associated with CRC or RC, but women who were ever pregnant had a HR of 1.87 (95%CI 1.12-3.14) compared to those never pregnant, and parous women had a HR of 1.79 (95% CI 1.10-2.92) compared to nulliparous women for CC. Use of oral contraceptives and hormone replacement therapy were not associated with CRC, CC or RC. Compared to women with normal BMI, women who were obese had HRs of 1.39 (95%CI 1.12-1.74) and 1.64 (95%CI 1.24-2.16) for CRC and CC respectively. No increased risk was seen for RC. Adjusted for BMI, for colonic cancer, women in the highest quartile for Waist Circumference had a HR of 2.14 (95%CI 1.42-3.25) compared to the lowest quartile, for Waist Hip Ratio, a HR of 1.74 (95%CI 1.30-2.34), and for Waist-Height ratio, a HR of 1.80 (1.26-2.57). None of these measures were significantly associated with RC. CONCLUSIONS Obesity is positively associated with CC but not RC, and abdominal obesity exerts an independent effect. Reproductive factors had at best a weak effect on CC and RC.
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Manchanda R, Patel S, Gordeev VS, Antoniou AC, Smith S, Lee A, Hopper JL, MacInnis RJ, Turnbull C, Ramus SJ, Gayther SA, Pharoah PDP, Menon U, Jacobs I, Legood R. Cost-effectiveness of Population-Based BRCA1, BRCA2, RAD51C, RAD51D, BRIP1, PALB2 Mutation Testing in Unselected General Population Women. J Natl Cancer Inst 2018; 110:714-725. [PMID: 29361001 DOI: 10.1093/jnci/djx265] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/20/2017] [Indexed: 02/11/2024] Open
Abstract
Background The cost-effectiveness of population-based panel testing for high- and moderate-penetrance ovarian cancer (OC)/breast cancer (BC) gene mutations is unknown. We evaluate the cost-effectiveness of population-based BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 mutation testing compared with clinical criteria/family history (FH) testing in unselected general population women. Methods A decision-analytic model comparing lifetime costs and effects of criteria/FH-based BRCA1/BRCA2 testing is compared with BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 testing in those fulfilling clinical criteria/strong FH of cancer (≥10% BRCA1/BRCA2 probability) and all women age 30 years or older. Analyses are presented for UK and US populations. Identified carriers undergo risk-reducing salpingo-oophorectomy. BRCA1/BRCA2/PALB2 carriers can opt for magnetic resonance imaging/mammography, chemoprevention, or risk-reducing mastectomy. One-way and probabilistic sensitivity analysis (PSA) enabled model uncertainty evaluation. Outcomes include OC, BC, and additional heart disease deaths. Quality-adjusted life-years (QALYs), OC incidence, BC incidence, and incremental cost-effectiveness ratio (ICER) were calculated. The time horizon is lifetime and perspective is payer. Results Compared with clinical criteria/FH-based BRCA1/BRCA2 testing, clinical criteria/FH-based BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 testing is cost-effective (ICER = £7629.65/QALY or $49 282.19/QALY; 0.04 days' life-expectancy gained). Population-based testing for BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 mutations is the most cost-effective strategy compared with current policy: ICER = £21 599.96/QALY or $54 769.78/QALY (9.34 or 7.57 days' life-expectancy gained). At £30 000/QALY and $100 000/QALY willingness-to-pay thresholds, population-based BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 panel testing is the preferred strategy in 83.7% and 92.7% of PSA simulations; criteria/FH-based panel testing is preferred in 16.2% and 5.8% of simulations, respectively. Population-based BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 testing can prevent 1.86%/1.91% of BC and 3.2%/4.88% of OC in UK/US women: 657/655 OC cases and 2420/2386 BC cases prevented per million. Conclusions Population-based BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 testing is more cost-effective than any clinical criteria/FH-based strategy. Clinical criteria/FH-based BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 testing is more cost-effective than BRCA1/BRCA2 testing alone.
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Affiliation(s)
- Ranjit Manchanda
- Centre for Experimental Cancer Medicine, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, UK
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Shreeya Patel
- Centre for Experimental Cancer Medicine, Queen Mary University of London, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Vladimir S Gordeev
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Shantel Smith
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Lee
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Clare Turnbull
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Susan J Ramus
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
| | | | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Usha Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Ian Jacobs
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
- University of New South Wales, Sydney, NSW, Australia
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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12
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Neumeyer S, Banbury BL, Arndt V, Berndt SI, Bezieau S, Bien SA, Buchanan DD, Butterbach K, Caan BJ, Campbell PT, Casey G, Chan AT, Chanock SJ, Dai JY, Gallinger S, Giovannucci EL, Giles GG, Grady WM, Hampe J, Hoffmeister M, Hopper JL, Hsu L, Jenkins MA, Joshi A, Larsson SC, Le Marchand L, Lindblom A, Moreno V, Lemire M, Li L, Lin Y, Offit K, Newcomb PA, Pharaoh PD, Potter JD, Qi L, Rennert G, Schafmayer C, Schoen RE, Slattery ML, Song M, Ulrich CM, Win AK, White E, Wolk A, Woods MO, Wu AH, Gruber SB, Brenner H, Peters U, Chang-Claude J. Mendelian randomisation study of age at menarche and age at menopause and the risk of colorectal cancer. Br J Cancer 2018; 118:1639-1647. [PMID: 29795306 PMCID: PMC6008474 DOI: 10.1038/s41416-018-0108-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background Substantial evidence supports an association between use of menopausal hormone therapy and decreased colorectal cancer (CRC) risk, indicating a role of exogenous sex hormones in CRC development. However, findings on endogenous oestrogen exposure and CRC are inconsistent. Methods We used a Mendelian randomisation approach to test for a causal effect of age at menarche and age at menopause as surrogates for endogenous oestrogen exposure on CRC risk. Weighted genetic risk scores based on 358 single-nucleotide polymorphisms associated with age at menarche and 51 single-nucleotide polymorphisms associated with age at menopause were used to estimate the association with CRC risk using logistic regression in 12,944 women diagnosed with CRC and 10,741 women without CRC from three consortia. Sensitivity analyses were conducted to address pleiotropy and possible confounding by body mass index. Results Genetic risk scores for age at menarche (odds ratio per year 0.98, 95% confidence interval: 0.95–1.02) and age at menopause (odds ratio 0.98, 95% confidence interval: 0.94–1.01) were not significantly associated with CRC risk. The sensitivity analyses yielded similar results. Conclusions Our study does not support a causal relationship between genetic risk scores for age at menarche and age at menopause and CRC risk.
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Affiliation(s)
- Sonja Neumeyer
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Barbara L Banbury
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98124, USA
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892-9776, USA
| | - Stephane Bezieau
- Centre Hospitalier Universitaire (CHU), Nantes Service de Génétique Médicale, 44093, Nantes, France
| | - Stephanie A Bien
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98124, USA
| | - Dan D Buchanan
- Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Katja Butterbach
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Bette J Caan
- Division of Research, Kaiser Permanente Medical Care Program of Northern California, Oakland, 94612, CA, USA
| | - Peter T Campbell
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, 30329-4251, USA
| | - Graham Casey
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, 22908, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.,Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892-9776, USA
| | - James Y Dai
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98124, USA
| | - Steven Gallinger
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, M5G 1 X 5, Canada
| | - Edward L Giovannucci
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, 02115, USA.,Department of Nutrition, Harvard School of Public Health, Boston, MA, 02115, USA.,Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia.,Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, VIC, 3010, Australia
| | - William M Grady
- Department of Medicine, Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, 98195, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, TU Dresden, 01307, Dresden, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Li Hsu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98124, USA
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Amit Joshi
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, 02115, USA
| | - Susanna C Larsson
- Institute of Environmental Medicine, Karolinska Institutet Solna, SE-171 77, Stockholm, Sweden
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, 96822, HI, USA
| | - Annika Lindblom
- Department of Clinical Genetics, Karolinska University Hospital Solna, SE-171 77, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet Solna, SE-171 77, Stockholm, Sweden
| | - Victor Moreno
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08028, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain and University of Barcelona, Barcelona, 08007, Spain
| | - Mathieu Lemire
- Ontario Institute for Cancer Research, Toronto, ON, M5G 0A3, Canada
| | - Li Li
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Yi Lin
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98124, USA
| | - Kenneth Offit
- Department of Medicine, Clinical Genetics Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98124, USA
| | - Paul D Pharaoh
- Centre for Cancer Genetic Epidemiology, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 8AR, UK
| | - John D Potter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98124, USA
| | - Lihong Qi
- Department of Public Health Sciences, University of California, Davis, CA, 95817, USA
| | - Gad Rennert
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Clalit Health Services National Israeli Cancer Control Center, Haifa, 34361, Israel.,Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, 34361, Israel
| | - Clemens Schafmayer
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24118, Kiel, Germany
| | - Robert E Schoen
- Department of Medicine and Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Martha L Slattery
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, 84108, USA
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, 02115, USA.,Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Department of Nutrition, Harvard School of Public Health, Boston, MA, 02115, USA
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT, 84112, USA
| | - Aung K Win
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia.,Genetic Medicine and Familial Cancer Centre, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | - Emily White
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98124, USA
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet Solna, SE-171 77, Stockholm, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, SE-171 77, Sweden
| | - Michael O Woods
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Anna H Wu
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Stephen B Gruber
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120, Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98124, USA
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany. .,Genetic Tumour Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, 20246, Hamburg, Germany.
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13
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Troisi R, Bjørge T, Gissler M, Grotmol T, Kitahara CM, Sæther SMM, Ording AG, Sköld C, Sørensen HT, Trabert B, Glimelius I. The role of pregnancy, perinatal factors and hormones in maternal cancer risk: a review of the evidence. J Intern Med 2018; 283:430-445. [PMID: 29476569 PMCID: PMC6688839 DOI: 10.1111/joim.12747] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
An understanding of the origin of cancer is critical for cancer prevention and treatment. Complex biological mechanisms promote carcinogenesis, and there is increasing evidence that pregnancy-related exposures influence foetal growth cell division and organ functioning and may have a long-lasting impact on health and disease susceptibility in the mothers and offspring. Nulliparity is an established risk factor for breast, ovarian, endometrial and possibly pancreatic cancer, whilst the risk of kidney cancer is elevated in parous compared with nulliparous women. For breast, endometrial and ovarian cancer, each pregnancy provides an additional risk reduction. The associations of parity with thyroid and colorectal cancers are uncertain. The timing of reproductive events is also recognized to be important. Older age at first birth is associated with an increased risk of breast cancer, and older age at last birth is associated with a reduced risk of endometrial cancer. The risks of breast and endometrial cancers increase with younger age at menarche and older age at menopause. The mechanisms, and hormone profiles, that underlie alterations in maternal cancer risk are not fully understood and may differ by malignancy. Linking health registries and pooling of data in the Nordic countries have provided opportunities to conduct epidemiologic research of pregnancy exposures and subsequent cancer. We review the maternal risk of several malignancies, including those with a well-known hormonal aetiology and those with less established relationships. The tendency for women to have fewer pregnancies and at later ages, together with the age-dependent increase in the incidence of most malignancies, is expected to affect the incidence of pregnancy-associated cancer.
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Affiliation(s)
- Rebecca Troisi
- Division of Cancer Epidemiology and Biostatistics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Cari M. Kitahara
- Division of Cancer Epidemiology and Biostatistics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | | | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Sköld
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Britton Trabert
- Division of Cancer Epidemiology and Biostatistics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet Stockholm, Sweden
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14
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Patel S, Legood R, Evans DG, Turnbull C, Antoniou AC, Menon U, Jacobs I, Manchanda R. Cost effectiveness of population based BRCA1 founder mutation testing in Sephardi Jewish women. Am J Obstet Gynecol 2018; 218:431.e1-431.e12. [PMID: 29288066 DOI: 10.1016/j.ajog.2017.12.221] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/08/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Population-based BRCA1/BRCA2 founder-mutation testing has been demonstrated as cost effective compared with family history based testing in Ashkenazi Jewish women. However, only 1 of the 3 Ashkenazi Jewish BRCA1/BRCA2 founder mutations (185delAG[c.68_69delAG]), 5382insC[c.5266dupC]), and 6174delT[c.5946delT]) is found in the Sephardi Jewish population (185delAG[c.68_69delAG]), and the overall prevalence of BRCA mutations in the Sephardi Jewish population is accordingly lower (0.7% compared with 2.5% in the Ashkenazi Jewish population). Cost-effectiveness analyses of BRCA testing have not previously been performed at these lower BRCA prevalence levels seen in the Sephardi Jewish population. Here we present a cost-effectiveness analysis for UK and US populations comparing population testing with clinical criteria/family history-based testing in Sephardi Jewish women. STUDY DESIGN A Markov model was built comparing the lifetime costs and effects of population-based BRCA1 testing, with testing using family history-based clinical criteria in Sephardi Jewish women aged ≥30 years. BRCA1 carriers identified were offered magnetic resonance imaging/mammograms and risk-reducing surgery. Costs are reported at 2015 prices. Outcomes include breast cancer, ovarian cancer, and excess deaths from heart disease. All costs and outcomes are discounted at 3.5%. The time horizon is lifetime, and perspective is payer. The incremental cost-effectiveness ratio per quality-adjusted life-year was calculated. Parameter uncertainty was evaluated through 1-way and probabilistic sensitivity analysis. RESULTS Population testing resulted in gain in life expectancy of 12 months (quality-adjusted life-year = 1.00). The baseline discounted incremental cost-effectiveness ratio for UK population-based testing was £67.04/quality-adjusted life-year and for US population was $308.42/quality-adjusted life-year. Results were robust in the 1-way sensitivity analysis. The probabilistic sensitivity analysis showed 100% of simulations were cost effective at £20,000/quality-adjusted life-year UK and the $100,000/quality-adjusted life-year US willingness-to-pay thresholds. Scenario analysis showed that population testing remains cost effective in UK and US populations, even if premenopausal oophorectomy does not reduce breast cancer risk or if hormone replacement therapy compliance is nil. CONCLUSION Population-based BRCA1 testing is highly cost effective compared with clinical criteria-driven approach in Sephardi Jewish women. This supports changing the paradigm to population-based BRCA testing in the Jewish population, regardless of Ashkenazi/Sephardi ancestry.
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Affiliation(s)
- Shreeya Patel
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - D Gareth Evans
- Centre for Genomic Medicine, Division of Evolution and Genomic Science, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Clare Turnbull
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Usha Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom
| | - Ian Jacobs
- University of New South Wales, Sydney, New South Wales, Australia
| | - Ranjit Manchanda
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom; Department of Gynaecological Oncology, Barts Health National Health Service Trust, Royal London Hospital, London, United Kingdom.
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15
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Michels KA, Pfeiffer RM, Brinton LA, Trabert B. Modification of the Associations Between Duration of Oral Contraceptive Use and Ovarian, Endometrial, Breast, and Colorectal Cancers. JAMA Oncol 2018; 4:516-521. [PMID: 29346467 PMCID: PMC5885214 DOI: 10.1001/jamaoncol.2017.4942] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/06/2017] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although oral contraceptive (OC) use is common, the influence of OC use on carcinogenesis is not fully understood. A recent Agency for Healthcare Research and Quality report identified a need to understand the consistency of OC use and cancer associations across subpopulations, including smokers and obese women. OBJECTIVE To determine whether associations between duration of OC use and risk of specific cancers were modified by lifestyle characteristics. DESIGN, SETTING, AND PARTICIPANTS The prospective NIH-AARP Diet and Health Study (enrolled 1995-1996, followed until 2011), with population-based recruitment of AARP members in 6 states and 2 metropolitan areas. All analyses included at least 100 000 women who reported OC use at enrollment. We identified 1241 ovarian, 2337 endometrial, 11 114 breast, and 3507 colorectal cancer cases during follow-up. Data analysis was performed between September 2016 and April 2017. EXPOSURES Duration of OC use (never or <1 year [reference], 1-4, 5-9, or ≥10 years). MAIN OUTCOMES AND MEASURES Development of ovarian, endometrial, breast, and colorectal cancers. We examined effect modification by modifiable lifestyle characteristics: cigarette smoking, alcohol consumption, body mass index (BMI), and physical activity. We used Cox models adjusted for age, race, age at menarche, and the modifiers of interest. RESULTS The analytic population was aged 50 to 71 years (median, 62 years) at enrollment and largely white (91%) and postmenopausal (96%). For ovarian cancer, OC use-associated risk reductions strengthened with duration of use (long-term OC use [≥10 years] HR, 0.60; 95% CI, 0.47-0.76; P < .001 for trend) and were similar across modifiable lifestyle factors. Risk reductions for endometrial cancer strengthened with duration of use (long-term OC use HR, 0.66; 95% CI, 0.56-0.78; P < .001 for trend); the most pronounced reductions were among long-term OC users who were smokers (HR, 0.47; 95% CI, 0.25-0.88), had obese BMIs (0.36; 95% CI, 0.25-0.52), and who exercised rarely (HR, 0.40; 95% CI, 0.29-0.56). Associations between OC use and breast and colorectal cancers were predominantly null. CONCLUSIONS AND RELEVANCE Long-term OC use is consistently associated with reduced ovarian cancer risk across lifestyle factors. We observed the greatest risk reductions for endometrial cancer among women at risk for chronic diseases (ie, smokers, obese BMI). Oral contraceptive use may be beneficial for chemoprevention for a range of women with differing baseline cancer risks.
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Affiliation(s)
- Kara A. Michels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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16
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Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman WV, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM. No 329-Consensus canadien sur la contraception (4e partie de 4) : chapitre 9 – contraception hormonale combinée. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:269-314.e5. [DOI: 10.1016/j.jogc.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Murphy N, Xu L, Zervoudakis A, Xue X, Kabat G, Rohan TE, Wassertheil-Smoller S, O'Sullivan MJ, Thomson C, Messina C, Strickler HD, Gunter MJ. Reproductive and menstrual factors and colorectal cancer incidence in the Women's Health Initiative Observational Study. Br J Cancer 2017; 116:117-125. [PMID: 27898658 PMCID: PMC5220139 DOI: 10.1038/bjc.2016.345] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/19/2016] [Accepted: 09/25/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Reproductive and menstrual factors have been evaluated as surrogates for long-term hormonal exposures in several prospective studies of colorectal cancer, yet findings have been conflicting. METHODS The relation of reproductive and menstrual factors (self-reported via a reproductive history questionnaire) with incident colorectal cancer was investigated among women enrolled in the Women's Health Initiative Observational Study (WHI-OS), a longitudinal cohort of 93 676 postmenopausal women (aged 50-79 years at enrolment) in which 1149 incident cases of colorectal cancer occurred over a median follow-up of 11.9 years. Multivariable Cox proportional hazards models that included established colorectal cancer risk factors were constructed to examine the association of colorectal cancer incidence with reproductive and menstrual factors. RESULTS Having had two children (vs nulliparous: hazard ratio (HR)=0.80, 95% confidence interval (CI): 0.64-0.99) was inversely associated with colorectal cancer risk. Compared with never users, ever use of oral contraceptives was associated with lower colorectal cancer risk (HR=0.74, 95% CI: 0.63-0.86); however, no relationship was observed for duration of oral contraceptives use (4 years vs 1 year: HR=0.94, 95% CI: 0.67-1.32). None of the remaining reproductive and menstrual factors was associated with colorectal cancer incidence. CONCLUSIONS Parity and prior use of oral contraceptives were associated with lower colorectal cancer risk in this cohort of postmenopausal women.
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Affiliation(s)
- Neil Murphy
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
| | - Linzhi Xu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Alice Zervoudakis
- Department of Oncology, Montefiore Medical Center, Bronx, New York, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Geoffrey Kabat
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Mary Jo O'Sullivan
- Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
| | - Cynthia Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona Canyon Ranch Center for Prevention & Health Promotion, Tucson, AZ, USA
| | - Catherine Messina
- Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Howard D Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
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18
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Affiliation(s)
- Gad Rennert
- Clalit National Cancer Control Center and Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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19
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Lope V, Fernández de Larrea N, Pérez-Gómez B, Martín V, Moreno V, Costas L, Longo F, Jiménez-Moleón JJ, Llorca J, Ascunce N, Peiró-Pérez R, Altzibar JM, Tardón A, Alguacil J, Navarro C, Sierra Á, Vega AB, Villafañe A, Castaño-Vinyals G, Kogevinas M, Pollán M, Aragonés N. Menstrual and Reproductive Factors and Risk of Gastric and Colorectal Cancer in Spain. PLoS One 2016; 11:e0164620. [PMID: 27776142 PMCID: PMC5077095 DOI: 10.1371/journal.pone.0164620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/28/2016] [Indexed: 01/13/2023] Open
Abstract
Background Sex hormones play a role in gastric cancer and colorectal cancer etiology, however, epidemiological evidence is inconsistent. This study examines the influence of menstrual and reproductive factors over the risk of both tumors. Methods In this case-control study 128 women with gastric cancer and 1293 controls, as well as 562 female and colorectal cancer cases and 1605 controls were recruited in 9 and 11 Spanish provinces, respectively. Population controls were frequency matched to cases by age and province. Demographic and reproductive data were directly surveyed by trained staff. The association with gastric, colon and rectal cancer was assessed using logistic and multinomial mixed regression models. Results Our results show an inverse association of age at first birth with gastric cancer risk (five-year trend: OR = 0.69; p-value = 0.006). Ever users of hormonal contraception presented a decreased risk of gastric (OR = 0.42; 95%CI = 0.26–0.69), colon (OR = 0.64; 95%CI = 0.48–0.86) and rectal cancer (OR = 0.61; 95%CI = 0.43–0.88). Postmenopausal women who used hormone replacement therapy showed a decreased risk of colon and rectal tumors. A significant interaction of educational level with parity and months of first child lactation was also observed. Conclusion These findings suggest a protective role of exogenous hormones in gastric and colorectal cancer risk. The role of endogenous hormones remains unclear.
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Affiliation(s)
- Virginia Lope
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid 28029, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid 28222, Spain
- * E-mail:
| | - Nerea Fernández de Larrea
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid 28029, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
| | - Beatriz Pérez-Gómez
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid 28029, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid 28222, Spain
| | - Vicente Martín
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud, Universidad de León, León 24071, Spain
| | - Victor Moreno
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- IDIBELL-Catalan Institute of Oncology, L’Hospitalet de Llobregat, Barcelona 08907, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, L'Hospitalet del Llobregat, Barcelona 08907, Spain
| | - Laura Costas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, L’Hospitalet de Llobregat, Barcelona 08907, Spain
- Department of Medicine, University of Barcelona, L'Hospitalet del Llobregat, Barcelona 08907, Spain
| | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - José Juan Jiménez-Moleón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA)-Granada Health Research Institute (ibs.GRANADA), Granada 18012, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada 18016, Spain
| | - Javier Llorca
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Universidad de Cantabria-IDIVAL, Santander 39011, Spain
| | - Nieves Ascunce
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Navarra Breast Cancer Screening Programme, Public Health Institute, Pamplona 31003, Spain
| | - Rosana Peiró-Pérez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Cancer and Public Health Area, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia 46020, Spain
| | - Jone M. Altzibar
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Public Health Division of Gipuzkoa, Donostia 20013, San Sebastián, Spain
- Biodonostia Research Institute, Donostia 20014, San Sebastián, Spain
| | - Adonina Tardón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo 33006, Asturias, Spain
| | - Juan Alguacil
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Centro de Investigación en Salud y Medio Ambiente (CYSMA), Universidad de Huelva, Huelva 21071, Spain
| | - Carmen Navarro
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia 30008, Spain
- Department of Health and Social Sciences. Universidad de Murcia, Murcia 30003, Spain
| | - Ángeles Sierra
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid 28029, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid 28222, Spain
| | - Ana Belén Vega
- Gastroenterology, Hospital de Viladecans, Viladecans, Barcelona 08840, Spain
| | - Amaya Villafañe
- Servicio de Cirugía, Complejo Asistencial Universitario de León, León 24071, Spain
| | - Gemma Castaño-Vinyals
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona 08003, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
- Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona 08003, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
- Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain
| | - Marina Pollán
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid 28029, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid 28222, Spain
| | - Nuria Aragonés
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid 28029, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid 28029, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid 28222, Spain
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Reproductive history and risk of colorectal adenocarcinoma in parous women: a Nordic population-based case-control study. Br J Cancer 2016; 115:1416-1420. [PMID: 27701386 PMCID: PMC5129816 DOI: 10.1038/bjc.2016.315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/19/2016] [Accepted: 09/06/2016] [Indexed: 12/14/2022] Open
Abstract
Background: Data are conflicting regarding the role of endogenous sex hormones in colorectal carcinogenesis. In this large population-based study, we pooled data from birth and cancer registries in four Nordic countries, to evaluate the risk of colorectal adenocarcinoma in relation to women's reproductive history. Methods: We conducted a population-based case–control study among women registered in Nordic birth registries. The study included colorectal adenocarcinoma cases diagnosed in Denmark, Finland, Norway, and Sweden during 1967–2013 and up to 10 matched controls per case, in total 22 185 cases and 220 246 controls. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were derived from conditional logistic regression models. We had limited information available on possible confounders. Results: We found no evidence for associations between colorectal adenocarcinoma and parity, age at first and last birth, and time since first and last birth. The risk estimates were also close to unity for specific cancer subsites (proximal and distal colon and rectum). As well, when the analyses were stratified on menopausal status, parity, and mother's year of birth, no indication of associations was found. Conclusions: In this large, Nordic population-based study, no evidence for associations was found between women's reproductive history and colorectal adenocarcinoma in parous women.
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Manchanda R, Legood R, Antoniou AC, Gordeev VS, Menon U. Specifying the ovarian cancer risk threshold of 'premenopausal risk-reducing salpingo-oophorectomy' for ovarian cancer prevention: a cost-effectiveness analysis. J Med Genet 2016; 53:591-9. [PMID: 27354448 DOI: 10.1136/jmedgenet-2016-103800] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/01/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy (RRSO) is the most effective intervention to prevent ovarian cancer (OC). It is only available to high-risk women with >10% lifetime OC risk. This threshold has not been formally tested for cost-effectiveness. OBJECTIVE To specify the OC risk thresholds for RRSO being cost-effective for preventing OC in premenopausal women. METHODS The costs as well as effects of surgical prevention ('RRSO') were compared over a lifetime with 'no RRSO' using a decision analysis model. RRSO was undertaken in premenopausal women >40 years. The model was evaluated at lifetime OC risk levels: 2%, 4%, 5%, 6%, 8% and 10%. Costs and outcomes are discounted at 3.5%. Uncertainty in the model was assessed using both deterministic sensitivity analysis and probabilistic sensitivity analysis (PSA). Outcomes included in the analyses were OC, breast cancer (BC) and additional deaths from coronary heart disease. Total costs and effects were estimated in terms of quality-adjusted life-years (QALYs); incidence of OC and BC; as well as incremental cost-effectiveness ratio (ICER). DATA SOURCES Published literature, Nurses Health Study, British National Formulary, Cancer Research UK, National Institute for Health and Care Excellence guidelines and National Health Service reference costs. The time horizon is lifetime and perspective: payer. RESULTS Premenopausal RRSO is cost-effective at 4% OC risk (life expectancy gained=42.7 days, ICER=£19 536/QALY) with benefits largely driven by reduction in BC risk. RRSO remains cost-effective at >8.2% OC risk without hormone replacement therapy (ICER=£29 071/QALY, life expectancy gained=21.8 days) or 6%if BC risk reduction=0 (ICER=£27 212/QALY, life expectancy gained=35.3 days). Sensitivity analysis indicated results are not impacted much by costs of surgical prevention or treatment of OC/ BC or cardiovascular disease. However, results were sensitive to RRSO utility scores. Additionally, 37%, 61%, 74%, 84%, 96% and 99.5% simulations on PSA are cost-effective for RRSO at the 2%, 4%, 5%, 6%, 8% and 10% levels of OC risk, respectively. CONCLUSIONS Premenopausal RRSO appears to be extremely cost-effective at ≥4% lifetime OC risk, with ≥42.7 days gain in life expectancy if compliance with hormone replacement therapy is high. Current guidelines should be re-evaluated to reduce the RRSO OC risk threshold to benefit a number of at-risk women who presently cannot access risk-reducing surgery.
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Affiliation(s)
- Ranjit Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Vladimir S Gordeev
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Usha Menon
- Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK
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Risk of Colorectal Cancer After Ovarian Stimulation for In Vitro Fertilization. Clin Gastroenterol Hepatol 2016; 14:729-37.e5. [PMID: 26687912 DOI: 10.1016/j.cgh.2015.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Apart from lifestyle factors, sex hormones also seem to have a role in the etiology of colorectal cancer. This raises interest in the possible effects of fertility drugs, especially because the use of ovarian stimulation for in vitro fertilization (IVF) has strongly increased over the past decades. METHODS In 1996, a nationwide cohort study was set up to examine cancer risk in a population that included 19,158 women who received ovarian stimulation for IVF (IVF group) and 5950 women who underwent subfertility treatments other than IVF (non-IVF group). Cancer incidence was ascertained through linkage with the Netherlands Cancer Registry. Colorectal cancer risk in the IVF group was compared with those in the general population and in the non-IVF group. RESULTS After a median follow-up of 21 years, 109 colorectal cancers were observed. Compared with the general population, risk of colorectal cancer was not increased in the IVF group (standardized incidence ratio, 1.00; 95% confidence interval [CI], 0.80-1.23), and was significantly decreased in the non-IVF group (standardized incidence ratio, 0.58; 95% CI, 0.36-0.88). Women in the IVF group had a significant increase in risk compared with women in the non-IVF group (multivariable-adjusted hazard ratio, 1.80; 95% CI, 1.10-2.94). No trend emerged with more IVF cycles or more ampules of gonadotropins administered. Colorectal cancer risk did not increase with longer follow-up periods. CONCLUSIONS Although women who receive ovarian stimulation for IVF do not have an increased risk for colorectal cancer compared with the general population, findings from our nationwide cohort study indicate that their risk is increased compared with women who received subfertility treatments other than IVF. Further research is warranted to examine whether ovarian stimulation for IVF contributes to development of colorectal cancer.
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Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women. Gynecol Oncol 2015; 139:487-94. [DOI: 10.1016/j.ygyno.2015.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 12/21/2022]
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Tourassi G, Yoon HJ, Xu S, Han X. The utility of web mining for epidemiological research: studying the association between parity and cancer risk. J Am Med Inform Assoc 2015; 23:588-95. [PMID: 26615183 DOI: 10.1093/jamia/ocv141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/10/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The World Wide Web has emerged as a powerful data source for epidemiological studies related to infectious disease surveillance. However, its potential for cancer-related epidemiological discoveries is largely unexplored. METHODS Using advanced web crawling and tailored information extraction procedures, the authors automatically collected and analyzed the text content of 79 394 online obituary articles published between 1998 and 2014. The collected data included 51 911 cancer (27 330 breast; 9470 lung; 6496 pancreatic; 6342 ovarian; 2273 colon) and 27 483 non-cancer cases. With the derived information, the authors replicated a case-control study design to investigate the association between parity (i.e., childbearing) and cancer risk. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for each cancer type and compared to those reported in large-scale epidemiological studies. RESULTS Parity was found to be associated with a significantly reduced risk of breast cancer (OR = 0.78, 95% CI, 0.75-0.82), pancreatic cancer (OR = 0.78, 95% CI, 0.72-0.83), colon cancer (OR = 0.67, 95% CI, 0.60-0.74), and ovarian cancer (OR = 0.58, 95% CI, 0.54-0.62). Marginal association was found for lung cancer risk (OR = 0.87, 95% CI, 0.81-0.92). The linear trend between increased parity and reduced cancer risk was dramatically more pronounced for breast and ovarian cancer than the other cancers included in the analysis. CONCLUSION This large web-mining study on parity and cancer risk produced findings very similar to those reported with traditional observational studies. It may be used as a promising strategy to generate study hypotheses for guiding and prioritizing future epidemiological studies.
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Affiliation(s)
- Georgia Tourassi
- Health Data Sciences Institute, Biomedical Science and Engineering Center, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Hong-Jun Yoon
- Health Data Sciences Institute, Biomedical Science and Engineering Center, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Songhua Xu
- Information Systems Department, New Jersey Institute of Technology, Newark, NJ 07102, USA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA 30303, USA
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Brinton LA, Moghissi KS, Scoccia B, Lamb EJ, Trabert B, Niwa S, Ruggieri D, Westhoff CL. Effects of fertility drugs on cancers other than breast and gynecologic malignancies. Fertil Steril 2015; 104:980-988. [PMID: 26232746 DOI: 10.1016/j.fertnstert.2015.06.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the relationship of ovulation-stimulating drugs to risk of cancers other than breast and gynecologic malignancies. DESIGN Retrospective cohort study, with additional follow-up since initial report. SETTING Reproductive endocrinology practices. PATIENT(S) Among a cohort of 12,193 women evaluated for infertility between 1965 and 1988, a total of 9,892 women (81.1% of the eligible population) were followed through 2010, via passive and active (questionnaire) approaches. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Hazard ratios (HRs) and 95% confidence intervals (CIs) for various fertility treatment parameters for select cancers. RESULT(S) During 30.0 median years of follow-up (285,332 person-years), 91 colorectal cancers, 84 lung cancers, 55 thyroid cancers, and 70 melanomas were diagnosed among study subjects. Clomiphene citrate (CC), used by 38.1% of patients, was not associated with colorectal or lung cancer risks, but was related significantly to melanoma (HR = 1.95; 95% CI: 1.18-3.22), and non-significantly to thyroid cancer risks (HR = 1.57; 95% CI: 0.89-2.75). The highest melanoma risks were seen among those with the lowest drug exposure levels, but thyroid cancer risk was greatest among the heavily exposed patients (HR = 1.96; 95% CI: 0.92-4.17 for those receiving >2,250 mg). Clomiphene citrate-associated risks for thyroid cancer were somewhat higher among nulligravid, compared with gravid, women, but did not differ according to distinct causes of infertility. Gonadotropins, used by only 9.7% of subjects, were not related to risk of any of the assessed cancers. CONCLUSION(S) Our results provide support for continued monitoring of both melanoma and thyroid cancer risk among patients receiving fertility drugs.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
| | - Kamran S Moghissi
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Bert Scoccia
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois
| | | | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | | | | | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
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Falk RT, Dallal CM, Lacey JV, Bauer DC, Buist DSM, Cauley JA, Hue TF, LaCroix AZ, Tice JA, Pfeiffer RM, Xu X, Veenstra TD, Brinton LA. Estrogen Metabolites Are Not Associated with Colorectal Cancer Risk in Postmenopausal Women. Cancer Epidemiol Biomarkers Prev 2015; 24:1419-22. [PMID: 26104910 DOI: 10.1158/1055-9965.epi-15-0541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/05/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A potential protective role for estrogen in colon carcinogenesis has been suggested based on exogenous hormone use, but it is unclear from previous studies whether endogenous estrogens are related to colorectal cancer risk. These few prior studies focused on parent estrogens; none evaluated effects of estrogen metabolism in postmenopausal women. METHODS We followed 15,595 women (ages 55-80 years) enrolled in the Breast and Bone Follow-up to the Fracture Intervention Trial (B∼FIT) who donated blood between 1992 and 1993 for cancer through December 2004. A panel of 15 estrogen metabolites (EM), including estradiol and estrone, were measured in serum from 187 colorectal cancer cases and a subcohort of 501 women not using exogenous hormones at blood draw. We examined EM individually, grouped by pathway (hydroxylation at the C-2, C-4, or C-16 position) and by ratios of the groupings using Cox proportional hazards regression models. RESULTS No significant associations were seen for estrone (HRQ4 vs. Q1 = 1.15; 95% CI, 0.69-1.93; Ptrend = 0.54), estradiol (HRQ4 vs. Q1 = 0.98; 95% CI, 0.58-1.64; Ptrend > 0.99), or total EM (the sum of all EM; HRQ4 vs. Q1 = 1.35; 95% CI, 0.81-2.24; Ptrend = 0.33). Most metabolites in the 2-, 4-, or 16-pathway were unrelated to risk, although a borderline trend in risk was associated with high levels of 17-epiestriol. CONCLUSION Circulating estrogens and their metabolites were generally unrelated to colorectal cancer risk in postmenopausal women. IMPACT Additional studies are needed to understand how exogenous estrogen may prevent colorectal cancer.
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Affiliation(s)
- Roni T Falk
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
| | - Cher M Dallal
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland
| | - James V Lacey
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, California
| | - Douglas C Bauer
- Department of Medicine, University of California, San Francisco, California
| | | | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Trisha F Hue
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Andrea Z LaCroix
- Division of Epidemiology, University of California San Diego, La Jolla, California
| | - Jeffrey A Tice
- Department of Medicine, University of California, San Francisco, California
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Xia Xu
- Laboratory of Proteomics and Analytical Technologies, Advanced Technology Program, Leidos-Frederick (formerly SAIC-Frederick), Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | | | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Charlton BM, Wu K, Zhang X, Giovannucci EL, Fuchs CS, Missmer SA, Rosner B, Hankinson SE, Willett WC, Michels KB. Oral contraceptive use and colorectal cancer in the Nurses' Health Study I and II. Cancer Epidemiol Biomarkers Prev 2015; 24:1214-21. [PMID: 26063479 DOI: 10.1158/1055-9965.epi-15-0172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/14/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It remains unclear if oral contraceptive (OC) use is associated with the incidence of colorectal cancer. Few studies have examined this association by duration of OC use, time since last OC use, and different cancer subsites. METHODS Among 88,691 participants of the Nurses' Health Study I (NHSI) and 93,080 participants of the Nurses' Health Study II (NHSII), we assessed OC use every 2 years between 1976 and 2010 and categorized it as ever use, duration of use, and time since last use. We included incident colorectal cancer cases through 2010 (NHSI: age at diagnosis = 36-88, N = 1,764; NHSII: age at diagnosis = 33-64, N = 206). Multivariable hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards regression models. RESULTS Ever OC use was not associated with colorectal cancer in NHSI [1.01 (0.91, 1.12)] nor NHSII [1.03 (0.69, 1.53)]. In NHSII, when compared with never-users, longer durations (5+ years) of OC use were inversely associated with the risk of colon cancers (Ptrend = 0.02) but the number of endpoints was limited. No other colorectal cancer subsites were associated with OC durations or times since last OC use in either cohort. CONCLUSIONS In two large prospective cohorts, we found little evidence that OC use may be protective for colorectal cancer, except potentially with longer durations of use among younger women. IMPACT Our results do not support the previous initial studies that reported an inverse association of recent OC use with colorectal cancer but instead support newer, larger studies demonstrating no such association.
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Affiliation(s)
- Brittany M Charlton
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Kana Wu
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stacey A Missmer
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Division of Reproductive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Susan E Hankinson
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Boston, Massachusetts
| | - Walter C Willett
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karin B Michels
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Romaguera D, Ward H, Wark PA, Vergnaud AC, Peeters PH, van Gils CH, Ferrari P, Fedirko V, Jenab M, Boutron-Ruault MC, Dossus L, Dartois L, Hansen CP, Dahm CC, Buckland G, Sánchez MJ, Dorronsoro M, Navarro C, Barricarte A, Key TJ, Trichopoulou A, Tsironis C, Lagiou P, Masala G, Pala V, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita HB, Siersema PD, Ohlsson B, Jirström K, Wennberg M, Nilsson LM, Weiderpass E, Kühn T, Katzke V, Khaw KT, Wareham NJ, Tjønneland A, Boeing H, Quirós JR, Gunter MJ, Riboli E, Norat T. Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study. BMC Med 2015; 13:107. [PMID: 25948112 PMCID: PMC4423114 DOI: 10.1186/s12916-015-0332-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/20/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients. METHODS The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4 years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2 years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. RESULTS The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models. CONCLUSIONS Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.
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Affiliation(s)
- Dora Romaguera
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
- Instituto de Investigación Sanitaria de Palma (IdISPa), Hospital Universitario Son Espases, Research Unit I-1, Ctra. de Valldemossa 79, 07010, Palma de Mallorca, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain.
| | - Heather Ward
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
| | - Petra A Wark
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
| | - Anne-Claire Vergnaud
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
| | - Petra H Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500 3508 GA, Utrecht, The Netherlands.
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500 3508 GA, Utrecht, The Netherlands.
| | - Pietro Ferrari
- International Agency for Cancer Research (IARC), 150 Cours Albert Thomas, 69372, Lyon, CEDEX 08, France.
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, USA.
- Winship Cancer Institute, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Mazda Jenab
- International Agency for Cancer Research (IARC), 150 Cours Albert Thomas, 69372, Lyon, CEDEX 08, France.
| | - Marie-Christine Boutron-Ruault
- Inserm (Institut National de la Santé et de la Recherche Médicale), Centre for Research in Epidemiology and Population Health (CESP), U1018, Team 9, 114 rue Édouard Vaillant, 94805, Villejuif, Cedex, France.
- Univ Paris Sud, UMRS 1018, 114 rue Édouard Vaillant 94805, Villejuif, France.
- Gustave Roussy, 114 rue Édouard Vaillant 94805, Villejuif, France.
| | - Laure Dossus
- Inserm (Institut National de la Santé et de la Recherche Médicale), Centre for Research in Epidemiology and Population Health (CESP), U1018, Team 9, 114 rue Édouard Vaillant, 94805, Villejuif, Cedex, France.
- Univ Paris Sud, UMRS 1018, 114 rue Édouard Vaillant 94805, Villejuif, France.
- Gustave Roussy, 114 rue Édouard Vaillant 94805, Villejuif, France.
| | - Laureen Dartois
- Inserm (Institut National de la Santé et de la Recherche Médicale), Centre for Research in Epidemiology and Population Health (CESP), U1018, Team 9, 114 rue Édouard Vaillant, 94805, Villejuif, Cedex, France.
- Univ Paris Sud, UMRS 1018, 114 rue Édouard Vaillant 94805, Villejuif, France.
- Gustave Roussy, 114 rue Édouard Vaillant 94805, Villejuif, France.
| | - Camilla Plambeck Hansen
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark.
| | - Christina Catherine Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark.
| | - Genevieve Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Avda. de la Granvia de l'Hospitalet, 199-203, 08908, Barcelona, Spain.
| | - María José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Campus Universitario de Cartuja, Cuesta del Observatorio, 4, 18011, Granada, Spain.
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain.
| | - Miren Dorronsoro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain.
- Public Health Direction and Biodonostia Basque Regional Health Department, Avenida Navarra 4, 20013, San Sebastian, Spain.
| | - Carmen Navarro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain.
- Department of Epidemiology, Murcia Regional Health Council, Ronda de Levante, 11, 30008, Murcia, Spain.
- Department of Health and Social Sciences, Universidad de Murcia, Campus Universitario de Espinardo, s/n, 30100 Espinardo, Murcia, Spain.
| | - Aurelio Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain.
- Navarre Public Health Institute, C/ Leyre, 15 31003, Pamplona, Spain.
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK.
| | - Antonia Trichopoulou
- Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece.
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece.
| | - Christos Tsironis
- Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece.
| | - Pagona Lagiou
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M. Asias Street, Goudi, GR-115 27, Athens, Greece.
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Giovanna Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Via delle Oblate 4, 50141, Florence, Italy.
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, Milan, Italy.
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, Via Dante Alighieri 109, I-97100, ASP, Ragusa, Italy.
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
- HuGeF Foundation, via Nizza 52, Turin, Italy.
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, VIA PANSINI 5, 80131, Naples, Italy.
| | - H Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven / PO Box 1, 3720 BA, Bilthoven, The Netherlands.
- Department of Gastroenterology and Hepatology, University Medical Centre, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Bodil Ohlsson
- Division of Internal Medicine, Department of Clinical Sciences, Skane University Hospital, Malmo, Lund University, Inga-Maria Nilssons gata 32, 205 02, Lund, Sweden.
| | - Karin Jirström
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Barngatan 2B, SE- 221 85, Lund, Sweden.
| | - Maria Wennberg
- Public Health and Clinical Medicine, Nutritional Research, Umeå University, S-901 87, Umeå, Sweden.
| | - Lena M Nilsson
- Arctic Research Centre, Umeå University, S-901 87, Umeå, Sweden.
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, ISM - Universitetet i Tromsø, 9037, Tromsø, Norway.
- Department of Research, Cancer Registry of Norway, P.B. 5313, Majorstuen, 0304, Oslo, Norway.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden.
- Department of Genetic Epidemiology, Folkhälsan Research Center, Folkhälsan Research Center, Biomedicum 1, Haartmansgatan 8, PB 63 (B336b), FI-00014 University of Helsinki, Helsinki, Finland.
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
| | - Verena Katzke
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
| | - Kay-Tee Khaw
- University of Cambridge School of Clinical Medicine, Clinical Gerontology Unit Box 251, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
| | - Nick J Wareham
- MRC Epidemiology Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, 69120, Germany.
| | - José R Quirós
- Public Health Directorate, Ciriaco Miguel Vigil 9, Oviedo, 33417, Asturias, Spain.
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
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Abstract
BACKGROUND Sex hormones may be associated with colorectal adenocarcinoma, although the association of pregnancy history and risk of colorectal cancer is not consistent. METHODS We conducted a population-based nested case-control study of persons born between 1932 and 2008 who are in the Swedish Multi-Generation Register. In total, 12,915 women and 15,519 men with colorectal adenocarcinoma were identified during follow-up in the Swedish Cancer Register; 10 age- and sex-matched controls were selected for each case. Number of children and age at first and last birth were analyzed in relation to the risk of colorectal adenocarcinoma, using conditional logistic regression, to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Compared with women without children, women with 1 or 2 children had an OR of 1.02 (95% CI = 0.93-1.13) of developing adenocarcinoma in the proximal colon; those with 3 or 4 children, 1.18 (1.06-1.32); and those with ≥5 children, 1.30 (1.05-1.61) (test for trend P < 0.01). The corresponding associations in men were 0.92 (0.84-1.00), 1.02 (0.92-1.13), and 0.97 (0.78-1.20), respectively (test for trend P = 0.13). CONCLUSIONS Higher parity in women was associated with the risk of adenocarcinoma of the proximal colon, although not the distal colon or rectum. A similar risk with family size was not seen for fathers. Still, the influence of lifestyle factors cannot be ruled out.
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Luan NN, Wu L, Gong TT, Wang YL, Lin B, Wu QJ. Nonlinear reduction in risk for colorectal cancer by oral contraceptive use: a meta-analysis of epidemiological studies. Cancer Causes Control 2014; 26:65-78. [PMID: 25359305 DOI: 10.1007/s10552-014-0483-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/24/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE Although the relationship between oral contraceptive (OC) use and colorectal cancer (CRC) risk has been studied extensively, the results of epidemiological studies are controversial. Therefore, we carried out a meta-analysis of epidemiological studies to summarize the available evidence and to quantify the potential dose-response relation. METHODS We searched PubMed database for studies of OC use and CRC risk that were published until the end of March 2014. Random- and fixed-effects models were applied to estimate summary relative risks (RRs) and 95 % confidence intervals (CIs). RESULTS Twelve cohorts and seventeen case-control studies with a total of 15,790 CRC cases were included in the final analysis. The summary RR for the ever versus never category of OC use was 0.82 (95 % CI 0.76-0.88). Similar result was observed when we compared the longest duration of OC use with the shortest duration (RR = 0.86, 95 % CI 0.76-0.96). Furthermore, the results of stratified analysis were comparable to those of overall meta-analysis. In dose-response analysis, significant inverse associations emerged in nonlinear models for the duration of OC use and CRC (P nonlinearity = 0.001). The greatest risk reduction was observed when the duration of OC use was approximately 42 months. There was moderate heterogeneity in the analysis, and no evidence of small-study bias was observed. CONCLUSIONS Based on the findings of this meta-analysis, ever use of OC is associated with lower risk of CRC. Additionally, there is a statistically significant nonlinear inverse association between the duration of OC use and CRC risk.
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Affiliation(s)
- Nan-Nan Luan
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, People's Republic of China
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Pericleous M, Mandair D, Caplin ME. Diet and supplements and their impact on colorectal cancer. J Gastrointest Oncol 2013; 4:409-23. [PMID: 24294513 DOI: 10.3978/j.issn.2078-6891.2013.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/17/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Colorectal cancer is the third commonest cancer and the third leading cause of cancer death among men and women. It has been proposed that dietary factors are responsible for 70-90% of colorectal cancer and diet optimization may prevent most cases. AIM To evaluate the role of dietary components and supplements in colorectal cancer. METHODS Bibliographical searches were performed in Pubmed for the terms "diet and colorectal cancer", "diet and colon cancer", "diet and rectal cancer", "nutrition and colorectal cancer", "probiotics and colorectal cancer", "prebiotics and colorectal cancer", "alcohol and cancer" and "colorectal cancer epidemiology". RESULTS Consumption of processed or red meat, especially when cooked at high temperatures may be associated with increased risk of colorectal cancer. The evidence for dietary fibre is unclear but foods that contain high amounts of fibre are usually rich in polyphenols which have been shown to alter molecular processes that can encourage colorectal carcinogenesis. Meta-analyses provide evidence on the benefits of circulating, diet-derived and supplemented, vitamin D and Calcium. We also found that diets rich in Folate may prevent colorectal carcinoma. The evidence on dietary micronutrients such as Zinc and Selenium in association with colorectal cancer is not conclusive. It has been suggested that there may be a direct association between alcohol intake and colorectal cancer. In vitro and in vivo studies have highlighted a possible protective role of prebiotics and probiotics. CONCLUSIONS The lack of randomized trials and the presence of confounding factors including smoking, physical activity, obesity and diabetes may often yield inconclusive results. Carefully designed randomized trials are recommended.
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Guan HB, Wu QJ, Gong TT, Lin B, Wang YL, Liu CX. Parity and risk of colorectal cancer: a dose-response meta-analysis of prospective studies. PLoS One 2013; 8:e75279. [PMID: 24098689 PMCID: PMC3787107 DOI: 10.1371/journal.pone.0075279] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 08/14/2013] [Indexed: 12/25/2022] Open
Abstract
Background Association between parity and colorectal cancer (CRC) risk has been investigated by several epidemiological studies but results are controversial, yet a comprehensive and quantitative assessment of this association has not been reported so far. Methods Relevant published studies of parity and CRC were identified using MEDLINE, EMBASE and Web of Science databases through end of April 2013. Two authors independently assessed eligibility and extracted data. Eleven prospective studies reported relative risk (RR) estimates and 95% confidence intervals (CIs) of CRC risk associated with parity. We pooled the RR from individual studies using fixed- or random-effects models and carried out heterogeneity and publication bias analyses. Results The summary RR for the ever parity vs. nulliparous was 0.95 (95% CI: 0.88–1.02), with no heterogeneity (Q = 9.04, P = 0.443, I2 = 0.5%). Likewise, no significant association was yielded for the highest vs. lowest parity number (RR = 1.02, 95% CI: 0.89–1.17), with moderate heterogeneity (Q = 17.48, P = 0.094, I2 = 37.1%). Dose-response analysis still indicated no effect of parity on CRC risk and the summary RR of per one livebirth was 0.99 (95% CI: 0.96–1.02), with moderate of heterogeneity (Q = 16.50, P<0.021, I2 = 57.6%). Similar results were observed among all the subgroup analyses. No evidence of publication bias and significant heterogeneity between subgroups were detected by meta-regression analyses. Conclusion Results of this dose-response meta-analysis of prospective studies found that there was little evidence of an association between parity and CRC risk.
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Affiliation(s)
- Hong-Bo Guan
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- State Key Laboratory of Oncogene and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Bei Lin
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yong-Lai Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Cai-Xia Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China
- * E-mail:
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Gierisch JM, Coeytaux RR, Urrutia RP, Havrilesky LJ, Moorman PG, Lowery WJ, Dinan M, McBroom AJ, Hasselblad V, Sanders GD, Myers ER. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomarkers Prev 2013; 22:1931-43. [PMID: 24014598 DOI: 10.1158/1055-9965.epi-13-0298] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oral contraceptives may influence the risk of certain cancers. As part of the AHRQ Evidence Report, Oral Contraceptive Use for the Primary Prevention of Ovarian Cancer, we conducted a systematic review to estimate associations between oral contraceptive use and breast, cervical, colorectal, and endometrial cancer incidence. We searched PubMed, Embase, and Cochrane Database of Systematic Reviews. Study inclusion criteria were women taking oral contraceptives for contraception or ovarian cancer prevention; includes comparison group with no oral contraceptive use; study reports quantitative associations between oral contraceptive exposure and relevant cancers; controlled study or pooled patient-level meta-analyses; sample size for nonrandomized studies ≥100; peer-reviewed, English-language; published from January 1, 2000 forward. Random-effects meta-analyses were conducted by estimating pooled ORs with 95% confidence intervals (CIs). We included 44 breast, 12 cervical, 11 colorectal, and 9 endometrial cancers studies. Breast cancer incidence was slightly but significantly increased in users (OR, 1.08; CI, 1.00-1.17); results show a higher risk associated with more recent use of oral contraceptives. Risk of cervical cancer was increased with duration of oral contraceptive use in women with human papillomavirus infection; heterogeneity prevented meta-analysis. Colorectal cancer (OR, 0.86; CI, 0.79-0.95) and endometrial cancer incidences (OR, 0.57; CI, 0.43-0.77) were significantly reduced by oral contraceptive use. Compared with never use, ever use of oral contraceptives is significantly associated with decreases in colorectal and endometrial cancers and increases in breast cancers. Although elevated breast cancer risk was small, relatively high incidence of breast cancers means that oral contraceptives may contribute to a substantial number of cases.
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Affiliation(s)
- Jennifer M Gierisch
- Authors' Affiliations: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center; Duke Evidence-Based Practice Center, Duke Clinical Research Institute; Departments of Medicine, Community and Family Medicine, Obstetrics and Gynecology, and Biostatistics and Bioinformatics, Duke University School of Medicine; Duke Cancer Institute, Duke University Health System; Duke Clinical Research Institute, Durham; and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Li CY, Song B, Wang YY, Meng H, Guo SB, Liu LN, Lv HC, Wu QJ. Age at menarche and risk of colorectal cancer: a meta-analysis. PLoS One 2013; 8:e65645. [PMID: 23762403 PMCID: PMC3675201 DOI: 10.1371/journal.pone.0065645] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/25/2013] [Indexed: 12/30/2022] Open
Abstract
Background Various observational studies have focused on the relationship between menarcheal age and the risk of colorectal cancer (CRC). However, the association is still controversial because of inconsistent results. Therefore, we performed a meta-analysis to assess this issue from epidemiological studies. Methods After a literature search in MEDLINE, EMBASE, and Web of Science for studies of menarcheal age and CRC risk published through the end of January 2013, we pooled the relative risks (RRs) from included studies using a fixed- or random-effects model and performed heterogeneity and publication bias analyses. All statistical tests were two-sided. Results Eleven case-control and 11 cohort studies were eligible for inclusion in our analysis. The random-effects pooled RR for oldest versus youngest menarcheal age was 0.95 [95% confidence intervals (CIs) = 0.85–1.06], with significant heterogeneity (Q = 61.03, P<0.001, I2 = 65.6%). When separately analyzed, case-control (RR = 0.95, 95% CI = 0.75–1.21) and cohort studies (RR = 0.97, 95% CI = 0.90–1.04) yielded similar results. Moreover, similar results were also observed among the subgroup analyses by study quality, population, exposure assessment, anatomic cancer site, subsite of colon cancer, and several potential important confounders and risk factors. There was no evidence of publication bias and significant heterogeneity between subgroups detected by meta-regression analyses. Conclusions Findings from this meta-analysis demonstrated that menarcheal age was not associated with the risk of CRC in humans. Further studies are warranted to stratify results by the subsite of colon cancer and menopause status in the future.
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Affiliation(s)
- Chun-Yan Li
- Department of Gastroenterology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
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Affiliation(s)
- Rebecca H Allen
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA. rhallen@wihri
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Rudolph A, Toth C, Hoffmeister M, Roth W, Herpel E, Schirmacher P, Brenner H, Chang-Claude J. Colorectal cancer risk associated with hormone use varies by expression of estrogen receptor-β. Cancer Res 2013; 73:3306-15. [PMID: 23585455 DOI: 10.1158/0008-5472.can-12-4051] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The risk of colorectal cancer is reduced among users of oral contraceptives or menopausal hormone therapy, but associations with reproductive characteristics that are markers of a woman's endogenous hormone milieu have not been consistently observed. To help understand possible mechanisms through which exogenous and endogenous hormonal exposures are involved in colorectal cancer, we assessed the risk of these malignancies according to tumor expression of estrogen receptor-β (ESR2). In a population-based study of postmenopausal women (503 cases and 721 controls matched for sex and age), immunohistochemical expression of ESR2 was determined in 445 cases of incident colorectal cancer. Unconditional logistic regression was used in case-case analyses to assess heterogeneity between risk associations according to ESR2 status and in case-control analyses to estimate associations separately for ESR2-negative and ESR2-positive tumors. For ESR2-positive tumors but not ESR2-negative tumors, colorectal cancer risk significantly decreased with duration of oral contraceptive use [per five-year increments OR ESR2-positive, 0.87, 95% confidence interval (CI), 0.77-0.99; OR ESR2-negative, 1.02, 95% CI, 0.91-1.15; Pheterogeneity = 0.07] and with duration of menopausal hormone therapy use (per five-year increments OR ESR2-positive, 0.84, 95% CI, 0.74-0.95; OR ESR2-negative, 0.94, 95% CI 0.84-1.05; Pheterogeneity = 0.06). Significant heterogeneity according to ESR2 expression was found for the association with current use of menopausal hormone therapy (<0.5 years ago; Pheterogeneity = 0.023) but not for associations with reproductive factors. In conclusion, our results suggest that hormone use decreases risk for ESR2-positive but not ESR2-negative colorectal cancer.
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Affiliation(s)
- Anja Rudolph
- Divisions of Cancer Epidemiology, Clinical Epidemiology and Aging Research, and Molecular Tumor Pathology, German Cancer Research Center, Heidelberg, Germany
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37
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Mortality of colorectal cancer in Taiwan, 1971-2010: temporal changes and age-period-cohort analysis. Int J Colorectal Dis 2012; 27:1665-72. [PMID: 22772747 DOI: 10.1007/s00384-012-1521-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Colorectal cancer (CRC) is the second most common cause of cancer death in developed countries among men (after lung cancer) and the third most common among women. This study thus examines the long-term trends of CRC mortality in Taiwan. METHODS CRC cases were collective between patients aged 30 years or older and younger than 85 years from the Taiwan death registries during 1971-2010. Standard descriptive techniques such as age-standardized mortality rates (ASMR), aural percent change, and age-period-cohort analyses were used. RESULTS The increase of percentage change by each age group in men was higher than in women. The ASMR of CRC increased 2-fold for men and almost 1.5-fold for women during the periods 1971-1975 and 2006-2010. For age-period-cohort analysis, the estimated mortality rate increased steadily with age in both sexes, and plateaued at 175.29 per 100,000 people for men and 128.14 per 100,000 for women in the 80- to 84-year-old group. Period effects were weak in both sexes. Cohort effects were strong. Between 30 and 59 years of age, the sex ratio showed that the female CRC mortality rate was higher than that of their male counterparts. Conversely, the mortality risk of CRC in men was higher than that in women when they were between 60 and 84 years old. CONCLUSIONS The current findings showed a consistent increase in mortality from CRC over the years. Changes in the patient sex ratio indicated an important etiological role of sex hormones, especially in women aged 60 years or younger.
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38
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Laukaitis CM, Erdman SH, Gerner EW. Chemoprevention in patients with genetic risk of colorectal cancers. COLORECTAL CANCER 2012; 1:225-240. [PMID: 25221625 PMCID: PMC4162131 DOI: 10.2217/crc.12.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A number of genetic syndromes are known to convey a high risk of colorectal cancer. Current standards of medical practice for these patients involve genetic testing followed by screening and surgical procedures. Pharmaceutical therapies for any of these syndromes are limited in number and are generally not approved by any regulatory body for applications in these genetic groups. This review discusses advances in mechanistic understanding of the disease processes leading to the development of promising pharmaceutical therapies. Clinical trials of potential chemotherapeutic agents must focus on the reduction of disease-related events, including cancer and cancer-related mortality, in patients with genetic syndromes.
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Affiliation(s)
- Christina M Laukaitis
- The University of Arizona, Department of Medicine & Arizona Cancer Center, 1515 N. Campbell Ave, Tucson, AZ 85724, USA
| | - Steven H Erdman
- Divison of Gastroenterology, Hepatology & Nutrition, Nationwide Children’s Hospital & The Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Eugene W Gerner
- The University of Arizona, Department of Cellular & Molecular Medicine & Arizona Cancer Center, BIO5 Institute Oro Valley, 1580 E. Hanley Blvd, Tucson, AZ 85737, USA
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Liu ZH, Ogejo JA, Pruden A, Knowlton KF. Occurrence, fate and removal of synthetic oral contraceptives (SOCs) in the natural environment: a review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2011; 409:5149-61. [PMID: 21975000 DOI: 10.1016/j.scitotenv.2011.08.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/04/2011] [Accepted: 08/14/2011] [Indexed: 05/14/2023]
Abstract
Synthetic oral contraceptives (SOCs) are a group of compounds with progestagenic and/or androgenic activities, with some also possessing estrogenic activities. Recent research has documented that some of these emerging contaminants have adverse effects on aquatic organisms at very low concentrations. To facilitate the evaluation of their latent risks, published works on their occurrence and fate in the environment are reviewed. Androgenic/progestagenic relative potencies or relative binding affinity of these SOCs as well as their physicochemical properties and toxicity are summarized. Appropriate analytical methods are outlined for various environmental sample types, including methods of sample preparation and limit of detection/quantification (LOD/LOQ). Finally results on their occurrence and fate in wastewater treatment plants (WWTPs) and other environments are critically examined.
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MESH Headings
- Androgens/analysis
- Androgens/chemistry
- Androgens/metabolism
- Androgens/toxicity
- Animals
- Aquatic Organisms/chemistry
- Aquatic Organisms/drug effects
- Contraceptives, Oral, Synthetic/analysis
- Contraceptives, Oral, Synthetic/chemistry
- Contraceptives, Oral, Synthetic/metabolism
- Contraceptives, Oral, Synthetic/toxicity
- Environmental Monitoring/methods
- Estrogens/analysis
- Estrogens/chemistry
- Estrogens/metabolism
- Estrogens/toxicity
- Humans
- Limit of Detection
- Molecular Structure
- Progestins/analysis
- Progestins/chemistry
- Progestins/metabolism
- Progestins/toxicity
- Waste Disposal, Fluid/methods
- Water Pollutants, Chemical/analysis
- Water Pollutants, Chemical/chemistry
- Water Pollutants, Chemical/metabolism
- Water Pollutants, Chemical/toxicity
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Affiliation(s)
- Ze-hua Liu
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, VA 24061, United States.
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Zervoudakis A, Strickler HD, Park Y, Xue X, Hollenbeck A, Schatzkin A, Gunter MJ. Reproductive history and risk of colorectal cancer in postmenopausal women. J Natl Cancer Inst 2011; 103:826-34. [PMID: 21447807 DOI: 10.1093/jnci/djr101] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are conflicting data regarding the role of sex hormones in colorectal cancer development. Whereas clinical trials data indicate that hormone therapy use reduces the risk of colorectal cancer, data from prospective cohort studies suggest that circulating estrogen levels are positively associated with colorectal cancer risk. A surrogate measure of lifetime estrogen exposure is reproductive history. We investigated the relationship between reproductive factors and the risk of colorectal cancer. METHODS Subjects were postmenopausal women enrolled in the National Institutes of Health-American Association of Retired Persons Diet and Health Study, a cohort of 214,162 individuals (aged 50-71 years) that included 2014 incident cases of colorectal cancer that occurred over a mean follow-up of 8.2 years. Questionnaires were used to collect data on reproductive factors, including ages at menarche, birth of first child, and menopause; parity, and use of oral contraceptives. Multivariable Cox proportional hazards models were constructed to examine associations between these reproductive factors and the risk of colorectal cancer, with adjustment for established colorectal cancer risk factors. All statistical tests were two-sided. RESULTS Age at menopause (≥ 55 vs < 40 years: hazard ratio [HR] = 1.50, 95% confidence interval [CI] = 1.23 to 1.83; P(trend) = .008) and age at birth of first child (≥ 30 vs ≤ 19 years: HR = 1.26, 95% CI = 1.01 to 1.58; P(trend) = .05) were positively associated with the risk of colorectal cancer. Among women with no history of hormone therapy use, age at menarche (≥ 15 vs 11-12 years: HR = 0.73, 95% CI = 0.57 to 0.94; P(trend) = .02) and parity (≥ 5 children vs no children: HR = 0.80, 95% CI = 0.63 to 1.02; P(trend) = .10) were inversely associated with the risk of colorectal cancer. CONCLUSION These data support a role for sex hormones in colorectal tumorigenesis and suggest that greater endogenous estrogen exposure may increase the risk of colorectal cancer in postmenopausal women.
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